Devices, systems, and methods for providing surgical access and facilitating closure of surgical access openings

ABSTRACT

A guide member is configured for guiding a suture passer through a cannula and tissue surrounding the cannula to facilitate closure of an opening in tissue. The guide member includes a guide housing and an elongated guide shaft. The guide housing is configured for releasably engaging the guide member with the cannula and defines an entry aperture. The elongated guide shaft extends distally from the guide housing and defines an annular exterior surface. An exit aperture is defined through the annular exterior surface. The guide member defines a lumen extending from the entry aperture, through the guide housing and the elongated guide shaft, to the exit aperture. The entry aperture, lumen, and exit aperture cooperating to define a passageway extending through the guide member.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.14/445,230 filed Jul. 29, 2014, which claims benefit of and priority toU.S. Provisional Application No. 62/029,809 filed Jul. 28, 2014, U.S.Provisional Application No. 62/029,788 filed Jul. 28, 2014, U.S.Provisional Application No. 62/029,839 filed Jul. 28, 2014, U.S.Provisional Application No. 62/029,825 filed Jul. 28, 2014 and U.S.Provisional Application No. 61/861,732 filed Aug. 2, 2013, and thedisclosures of each of the above-identified applications are herebyincorporated by reference in their entirety.

This application is related to U.S. patent application Ser. No.14/445,396, filed on Jul. 29, 2014 (now U.S. Pat. No. 9,714,126), U.S.patent application Ser. No. 14/445,197, filed on Jul. 29, 2014 (now U.S.Pat. No. 9,918,712), and U.S. patent application Ser. No. 14/445,259,filed on Jul. 29, 2014 (now U.S. Pat. No. 9,700,303).

BACKGROUND Technical Field

The present disclosure relates to surgical access and closure ofsurgical access openings and, more particularly, to devices, systems,and methods that provide access to an internal surgical site through anopening in tissue and facilitate the closure of the opening in tissue.

Background of Related Art

Puncture wounds, wounds that pierce through tissue, may result fromtrauma or may be intentionally created in order to provide a surgicalaccess opening for accessing an internal surgical site of a patientduring surgical procedures. During endoscopic surgical procedures, forexample, a trocar device is utilized to puncture the peritoneum toprovide access by way of a cannula through the abdominal wall.Generally, a trocar and/or cannula is placed through the abdominal wallfor introduction of surgical instrumentation which is necessary to carryout one or more surgical tasks. In this manner, the surgeon mayintroduce a surgical instrument such as a forceps, scissors, clipapplier, stapler, biopsy device, or any other surgical instrument asnecessary to complete a particular surgical task or tasks. Once thetask(s) is complete, it is necessary to close the opening.

SUMMARY

The present disclosure provides devices, systems, and methods thatfacilitate accessing an internal surgical site through an opening intissue, performing one or more minimally-invasive surgical tasks withinthe internal surgical site, and closing the opening in tissue once thesurgical task(s) is complete. In particular, in accordance with aspectsof the present disclosure, a guide member configured for guiding asuture passer through a cannula and tissue surrounding the cannula tofacilitate closure of an opening in tissue is provided including a guidehousing and an elongated guide shaft. The guide housing is configuredfor releasably engaging the guide member with the cannula and defines afirst entry aperture. The elongated guide shaft extends distally fromthe guide housing and defines an annular exterior surface. A first exitaperture is defined through the annular exterior surface. The guidemember further defines a first lumen extending from the first entryaperture, through the guide housing and the elongated guide shaft, tothe first exit aperture. The first entry aperture, first lumen, andfirst exit aperture cooperate to define a first passageway extendingthrough the guide member.

In aspects, the first passageway extending through the guide memberdefines a linear path. Alternatively, the first passageway extendingthrough the guide member may define a curved path having a constantradius of curvature or a varying radius of curvature.

In aspects, the guide housing defines a second entry aperture, theelongated guide shaft defines a second exit aperture, and the guidemember defines a second lumen extending from the second entry aperture,through the guide housing and the elongated guide shaft, to the secondexit aperture. The second entry aperture, second lumen, and second exitaperture cooperate to define a second passageway extending through theguide member. The first and second passageways may overlap one anotherwithout intersecting one another, or may be both non-overlapping andnon-intersecting. Other configurations of the passageways are alsocontemplated.

In aspects, the elongated guide shaft includes a suture-retaining memberdisposed towards a distal end of the elongated guide shaft. Thesuture-retaining member is configured to retain a portion of a suturethereon.

In aspects, the elongated guide shaft includes a cleaning memberdisposed towards a distal end of the elongated guide shaft. The cleaningmember is configured to wipe against an interior surface of the cannulaupon insertion of the elongated guide shaft through the cannula.

In aspects, a sealing member is disposed within the first entryaperture, first lumen, or first exit aperture. The sealing member isconfigured to seal the first passageway in the absence of the suturepasser inserted through the first passageway and to establish a sealabout the suture passer when the suture passer is inserted through thefirst passageway.

In aspects, the guide housing is rotatably coupled to the elongatedguide shaft and is rotatable relative to the elongated guide shaftbetween a first position, wherein a proximal portion of the passagewayis disconnected from a distal portion of the passageway, and a secondposition, wherein the proximal portion of the passageway is aligned withthe distal portion of the passageway to fully form the passageway.

In aspects, the guide member includes a first component and a secondcomponent. Each of the first and second components includes a portion ofthe guide housing, the first entry aperture, the elongated guide shaft,the first exit aperture, and the first lumen. The first and secondcomponents are engagable with each other and, as such, fully form theguide housing, the first entry aperture, the elongated guide shaft, thefirst exit aperture, and the first lumen upon engagement with eachother.

Another guide member provided in accordance with aspects of the presentdisclosure is also configured for guiding a suture passer through acannula and tissue surrounding the cannula to facilitate closure of anopening in tissue. The guide member includes an inner shaft and an outersleeve. The inner shaft defines an entry opening, an exit opening, and achannel extending between the entry opening and the exit opening. Theouter sleeve is disposed about the inner shaft and is positioned toenclose at least a portion of the channel to define a passagewayextending between the entry opening and the exit opening.

In aspects, a ring is positionable about the inner shaft and the outersleeve to secure the inner shaft and the outer sleeve to one another.Alternatively, a cap may be positionable about the inner shaft and theouter sleeve to secure the inner shaft and the outer sleeve to oneanother. The ring or cap, where so provided, may further be configuredto releasably engage the cannula upon insertion of the guide member intothe cannula.

The outer sleeve may be configured to engage the inner shaft, forexample, via a snap-fit engagement, a track and slider engagement, or aprotrusion-recess engagement.

Any of the above aspects, to the extent consistent, may be utilized withany or all of the other aspects detailed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and features of the present disclosure are describedhereinbelow with references to the drawings, wherein:

FIG. 1 is a perspective view of a surgical access assembly provided inaccordance with the present disclosure;

FIG. 2 is a side view of an obturator of the surgical access assembly ofFIG. 1;

FIG. 3 is an exploded, perspective view of the obturator of FIG. 2;

FIG. 4A is an exploded, perspective view of a cannula of the surgicalaccess assembly of FIG. 1;

FIG. 4B is a perspective view of the cannula of FIG. 4A with the housingand elongated portion of the cannula shown separated from each other;

FIG. 5A is a first side view of the cannula of FIG. 4A with the housingremoved;

FIG. 5B is a second side view rotated 90 degrees of the cannula of FIG.4A with the housing removed;

FIG. 6A is a first side view of another cannula provided in accordancewith the present disclosure with the housing removed;

FIG. 6B is a second side view rotated 90 degrees of the cannula of FIG.6A with the housing removed;

FIG. 7 is a side view of the cannula of FIG. 4A with the housingremoved, a guide member engaged with the cannula, and a suture passerinserted through the guide member and cannula;

FIG. 8A is a first perspective view of the guide member of FIG. 7;

FIG. 8B is a second perspective view of the guide member of FIG. 7;

FIG. 9 is a side view of the cannula of FIG. 4A with the housingremoved, another guide member engaged with the cannula, and the suturepasser of FIG. 7 inserted through the guide member and cannula;

FIG. 10A is a side view of the guide member of FIG. 9;

FIG. 10B is a first perspective view of the guide member of FIG. 9;

FIG. 10C is a second perspective view of the guide member of FIG. 9;

FIG. 11 is a side view of the cannula of FIG. 4A including another guidemember engaged with the cannula and the suture passer of FIG. 7 insertedthrough the guide member and cannula;

FIG. 12A is a first perspective view of the guide member of FIG. 11;

FIG. 12B is a second perspective view of the guide member of FIG. 11;

FIG. 13 is a side view of the cannula of FIGS. 6A-6B including anotherguide member engaged with the cannula and the suture passer of FIG. 7inserted through the guide member and cannula;

FIG. 14A is a first side view of the guide member of FIG. 13;

FIG. 14B is a second side view rotated 90 degrees of the guide member ofFIG. 13;

FIG. 15 is a perspective view of the suture passer of FIG. 7;

FIG. 16A is an enlarged, perspective view of the distal end of thesuture passer of FIG. 7 disposed in an insertion/withdrawal condition;

FIG. 16B is an enlarged, perspective view of the distal end of thesuture passer of FIG. 7 disposed in a deployed condition;

FIG. 17A is a side, cut-away view of the proximal end of another suturepasser provided in accordance with the present disclosure disposed in aninsertion/withdrawal condition;

FIG. 17B is a perspective view of the distal end of the suture passer ofFIG. 17A disposed in the insertion/withdrawal condition;

FIG. 18A is a side, cut-away view of the proximal end of the suturepasser of FIG. 17A disposed in a piercing condition;

FIG. 18B is a perspective view of the distal end of the suture passer ofFIG. 17A disposed in the piercing condition;

FIG. 19A is a side, cut-away view of the proximal end of the suturepasser of FIG. 17A disposed in a deployed condition;

FIG. 19B is a perspective view of the distal end of the suture passer ofFIG. 17A disposed in the deployed condition;

FIG. 20A is a side, cut-away view of the proximal end of another suturepasser provided in accordance with the present disclosure, disposed in adeployed condition;

FIG. 20B is a perspective view of the distal end of the suture passer ofFIG. 20A, disposed in the deployed condition;

FIG. 21A is a side, cut-away view of the proximal end of the suturepasser of FIG. 20A, disposed in an insertion/withdrawal condition;

FIG. 21B is a perspective view of the distal end of the suture passer ofFIG. 20A, disposed in the insertion/withdrawal condition;

FIG. 22A is a side, cut-away view of the proximal end of the suturepasser of FIG. 20A, disposed in a piercing condition;

FIG. 22B is a perspective view of the distal end of the suture passer ofFIG. 20B, disposed in the piercing condition;

FIG. 23 is a side view of another guide member provided in accordancewith the present disclosure;

FIG. 24A is a side view of the guide member of FIG. 23 positioned forinsertion into the cannula of FIG. 4A;

FIG. 24B is a side view of the guide member of FIG. 23 being insertedinto the cannula of FIG. 4A;

FIG. 24C is a side view of the guide member of FIG. 23 being insertedfurther into the cannula of FIG. 4A;

FIG. 24D is a side view of the guide member of FIG. 23 fully insertedinto and engaged with the cannula of FIG. 4A;

FIG. 24E is a side view of the guide member of FIG. 23 being withdrawnfrom the cannula of FIG. 4A;

FIG. 25 is a side view of a portion of an elongated member of thecannula of FIG. 4A including a sealing member disposed thereabout;

FIG. 26 is a side view of the portion of the elongated member of thecannula of FIG. 4A including another sealing member disposed thereabout;

FIG. 27 is a side view of the portion of the elongated member of thecannula of FIG. 4A including yet another sealing member disposedthereabout;

FIG. 28 is a side view of the portion of the elongated member of thecannula of FIG. 4A including another sealing member disposed about oneof the slots defined therethrough;

FIG. 29 is a side view of another guide member provided in accordancewith the present disclosure;

FIG. 30A is a side view of the guide member of FIG. 29 positioned forinsertion into the cannula of FIG. 4A;

FIG. 30B is a side view of the guide member of FIG. 29 being insertedinto the cannula of FIG. 4A;

FIG. 30C is a side view of the guide member of FIG. 29 fully engagedwithin the cannula of FIG. 4A and positioned within an opening intissue;

FIG. 31A is an exploded, perspective view of another guide memberprovided in accordance with the present disclosure;

FIG. 31B is a perspective view of the guide member of FIG. 31A asassembled;

FIG. 32A is an exploded, perspective view of another guide memberprovided in accordance with the present disclosure;

FIG. 32B is a perspective view of the guide member of FIG. 32A asassembled;

FIG. 33A is an exploded, perspective view of another guide memberprovided in accordance with the present disclosure;

FIG. 33B is a perspective view of the guide member of FIG. 33A asassembled;

FIG. 34A is a perspective view of an insert forming part of and utilizedin the manufacture of a guide member in accordance with the presentdisclosure;

FIG. 34B is a perspective view of a guide member provided in accordancewith the present disclosure and formed utilizing the insert of FIG. 34A;

FIG. 35 is an exploded, perspective view of another guide memberprovided in accordance with the present disclosure;

FIG. 36A is an exploded, perspective view of another guide memberprovided in accordance with the present disclosure;

FIG. 36B is a perspective view of the guide member of FIG. 36A asassembled;

FIG. 37A is an exploded, perspective view of another guide memberprovided in accordance with the present disclosure;

FIG. 37B is a perspective view of the guide member of FIG. 37A asassembled;

FIG. 37C is a perspective view of another guide member provided inaccordance with the present disclosure;

FIG. 37D is a perspective, cross-sectional view of the guide member ofFIG. 37C taken along section line 37D-37D of FIG. 37C; and

FIG. 37E is a transverse, cross-sectional view of the guide member ofFIG. 37C illustrating molding plates utilized to facilitate formation ofthe guide member;

FIG. 38A is a side view of another guide member provided in accordancewith the present disclosure engaged within the cannula of FIG. 4A;

FIG. 38B is a longitudinal, cross-sectional view of guide member shownin FIG. 38A;

FIG. 39A is a side view of another guide member provided in accordancewith the present disclosure engaged within the cannula of FIG. 4A anddisposed in a first position relative to the cannula;

FIG. 39B is a side view of the guide member and cannula shown in FIG.39A wherein the guide member is disposed in a second position relativeto the cannula;

FIG. 40 is a longitudinal, cross-sectional view of the proximal end ofanother guide member provided in accordance with the present disclosure;

FIG. 41 is a longitudinal, cross-sectional view of the proximal end ofanother guide member provided in accordance with the present disclosure;

FIG. 42 is an exploded, side view of the proximal end of another guidemember provided in accordance with the present disclosure;

FIG. 43A is a longitudinal, cross-sectional view of another guide memberprovided in accordance with the present disclosure engaged within thecannula of FIG. 4A and disposed in a first position relative to thecannula;

FIG. 43B is a longitudinal, cross-sectional view of the guide member andcannula shown in FIG. 43A, wherein the guide member is disposed in asecond position relative to the cannula; and

FIG. 44 is a side view of the guide member of FIG. 12A engaged withinthe cannula of FIG. 4A and positioned within an opening in tissue,including a syringe assembly inserted through the guide member andcannula.

DETAILED DESCRIPTION OF THE EMBODIMENTS

As detailed below and illustrated in the figures, the present disclosureprovides devices, systems, and methods that facilitate accessing aninternal surgical site through an opening in tissue, performing one ormore minimally-invasive surgical tasks within the internal surgicalsite, and closing the opening in tissue once the surgical task(s) iscomplete without the need to remove the cannula. In the accompanyingfigures and in the description that follows, in which like referencenumerals identify similar or identical elements, the term “proximal”will refer to the end of the apparatus or portion thereof which isclosest to the operator during use, while the term “distal” will referto the end or portion which is farthest from the operator, as istraditional.

Turning now to FIGS. 1-4B, a surgical access assembly provided inaccordance with the present disclosure is shown generally identified byreference numeral 10. Surgical access assembly 10 includes an obturator11 and a cannula 100 that is configured to at least partially receiveobturator 11, as detailed below. Cannula 100 is configured to provide asubstantially fluid-tight seal between an internal surgical site withina patient and the outside atmosphere before, during, and after insertionof surgical instrumentation (not shown) through cannula 100 and into theinternal surgical site.

Referring to FIGS. 1-3, obturator 11 includes an obturator housing 12disposed in mechanical cooperation with an elongated obturator member14. Obturator housing 12 defines an opening 16 and includes a scoperetention member 17 adjacent opening 16. Scope retention member 17 isfabricated from an elastomeric material and is configured to engage anouter surface of an endoscope (not shown) inserted therethrough infrictional engagement therewith to assist in retaining the relativepositioning of the endoscope (not shown) within obturator 11.

Elongated obturator member 14 extends distally from obturator housing 12and includes an obturator shaft 18 mechanically coupled to obturatorhousing 12, and an optical member 20 disposed at the distal end ofobturator shaft 18. Obturator shaft 18 may be made from steel, apolymeric material, or any other suitable material. Optical member 20defines a hollow interior and includes a proximal section 22, a centralsection 24, and an atraumatic guiding nub 26. Elongated obturator member14 is configured for insertion through cannula 100 (FIG. 1) and definesa length greater than that of elongated tubular member 102 a of cannula100 such that optical member 20 of elongated obturator member 14 extendsdistally from elongated tubular member 102 a of cannula 100 in a fullyinserted position of obturator 11 relative to cannula 100 (see FIG. 1).Atraumatic guiding nub 26 of optical member 20 is configured tofacilitate the initial insertion of obturator 11 and cannula 100 throughan initial opening in tissue, e.g., a pre-cut scalpel incision, and theadvancement thereof between tissue layers to gently enlarge tissuewithout cutting or incising tissue. After this initial insertion andwith continued distal insertion, central section 24 and proximal portion22 of optical member 20 continue to gently enlarge the opening in tissueto facilitate atraumatic passage of elongated obturator member 14 ofobturator 11 and elongated tubular member 102 a of cannula 100 throughthe opening in tissue. A distal viewing tip of the endoscope (not shown)is insertable through obturator shaft 18 and into the hollow interior ofoptical member 20 to facilitate visualization of tissue adjacent opticalmember 20 during insertion and advancement through tissue.

Referring to FIGS. 1 and 4A-5B, cannula 100 of surgical access assembly10 includes an elongated portion 102 and a housing 110 including aproximal housing component 110 a and a distal housing component 110 b.Elongated portion 102 includes elongated tubular member 102 a and a basemember 102 b. Base member 102 b includes threading 129 configured toengage complementary threading 127 of distal housing component 110 b,e.g., via a bayonet connection, to releasably engage housing 110 andelongated portion 102 to each other. Base member 102 b further includesa valved insufflation port 103 allowing for the selective inflow andoutflow of insufflation fluid. A collar 104 is configured to be seatedwithin base member 102 b to retain a zero-closure seal 150 within basemember 102 b. Zero-closure seal 150 maintains a substantiallyfluid-tight seal between the internal surgical site and the outsideatmosphere in the absence of surgical instrumentation (not shown)inserted through cannula 100. Collar 104 further includes a tab 104 adisposed within a recess 104 b defined within base member 102 b andselectively movable within recess 104 b to unlock housing 110 from basemember 102 b, thus permitting disengagement of housing 110 from basemember 102 b. Elongated tubular member 102 a extends distally from basemember 102 b and may be formed from a translucent material, althoughother configurations are also contemplated. Elongated tubular member 102a is described in detail below.

Proximal and distal housing components 110 a, 110 b, respectively, ofhousing 110 are selectively engagable with each other via snap-fitengagement or other suitable arrangement to form housing 110.Alternatively, these component may be integrally formed with each other.Proximal and distal housing components 110 a, 110 b cooperate to retainan insert seal assembly 130 therebetween. Insert seal assembly 130 isconfigured provide a substantially fluid-tight seal about the outersurface of surgical instrumentation (not shown) passing therethrough.Insert seal assembly 130 may further include a centering featureconfigured to bias insert seal assembly 130 and, thus, surgicalinstrumentation (not shown) passing therethrough, towards a radiallycentered position relative to housing 110. Proximal housing component110 a defines a pair of radially opposed apertures 111 extendingtherethrough, the importance of which will be detailed below. Distalhousing component 110 b includes a pair of notches 126 configured tomechanically engage a pair of corresponding latches 19 associated withobturator housing 12 (see FIGS. 2-3) to selectively lock and unlockobturator 11 to and from cannula 100. More specifically, obturatorhousing 12 is configured to receive proximal housing component 110 atherein as elongated obturator member 14 (FIG. 2) is inserted intoelongated tubular member 102 a, ultimately such that latches 19 ofobturator 11 are received within notches 126 of distal housing component110 b to lock obturator 11 and cannula 100 with each other. As notedabove, housing 110 and elongated portion 102 are releasably engagablewith each other, e.g., via engagement of threadings 127, 129,respectively. This releasable engagement facilitates the selectiveremoval of housing 110 and, thus, insert seal assembly 130, from cannula100 such that cannula assembly 100 may be utilized without insert sealassembly 130, and also ensures proper alignment of housing 110 withrespect to elongated portion 102 upon engagement therebetween, theimportance of which will be detailed below.

With reference in particular to FIGS. 5A-5B, elongated tubular member102 a of cannula 100 may be provided in various differentconfigurations, e.g., various diameters between about 10 mm to about 15mm and/or various lengths from about 70 mm to about 150 mm, althoughother suitable configurations are also contemplated. Elongated tubularmember 102 a may define a ribbed exterior (as shown) or may define agenerally smooth exterior, depending on a particular purpose. Elongatedtubular member 102 a is configured for positioning within an opening intissue and defines a longitudinal passageway 105 extending therethroughthat is configured to receive surgical instrumentation (not shown) forguiding the surgical instrumentation (not shown) through the opening intissue and into the internal surgical site. Passageway 105 of elongatedtubular member 102 a is further configured to receive elongatedobturator member 14 of obturator 11 (see FIG. 1) to facilitate insertionof elongated tubular member 102 a into the opening in tissue, asdetailed above, and is also configured to receive one or more guidemembers 300, 400, 500, and 600 (FIGS. 7, 9, 11, and 13, respectively),to facilitate closure of the opening in tissue after completion of thesurgical procedure, as detailed below.

A pair of opposed slots 106 extend through the annular side wall ofelongated tubular member 102 a, thus providing lateral access to andfrom longitudinal passageway 105 to and from the exterior of elongatedtubular member 102 a. Opposed slots 106 may be positioned along thelength of elongated tubular member 102 a at any suitable position, e.g.,closer to or further from base 102 b member of elongated portion 102 ofcannula 100. Thus, a cannula 100 including a particular positioning ofslots 106 may be selected based upon on the procedure being performed,the location of the opening in tissue, the patient's anatomy, the user'spreference, and/or other factors. For some procedures, it has been foundto be desirable that, once cannula 100 is positioned within the openingin tissue, slots 106 are positioned distally of the skin and fattylayers of tissue and adjacent to the fascia and muscle layers of tissuesince fascia and muscle layers are better suited to receive and retain asuture for closing the opening in tissue. Thus, a cannula 100 havingslots 106 positioned to achieve this configuration may be selected.However, other configurations are also contemplated. Further, as analternative or in addition to providing multiple cannulas 100 havingdifferently positioned slots 106, multiple pairs of opposed slots 106may be spaced-apart along the length of elongated tubular member 102 asuch that an appropriately positioned pair of slots 106 may be utilized,e.g., depending on the procedure being performed, the location of theopening in tissue, the patient's anatomy, the user's preference, and/orother factors.

Referring momentarily to FIGS. 25-28, elongated tubular member 102 a mayfurther include a sealing feature, e.g., sealing member 107 (FIG. 25),sealing member 108 (FIG. 26), sealing member 109 (FIG. 27), or sealingmember 160 (FIG. 28), sealingly disposed about each of slots 106 andconfigured to maintain a fluid-tight seal about elongated tubular member102 a to inhibit fluid exchange between longitudinal passageway 105(FIG. 5B) and the exterior of elongated tubular member 102 a via slots106. As can be appreciated, such a configuration allows for themaintenance of an insufflated internal surgical site during the courseof a surgical procedure. As detailed below, once maintaininginsufflation is no longer necessary and/or where access through slots106 is needed, e.g., after the surgical procedure has been completed,the respective sealing members 107, 108, 109, 160 (FIGS. 25-28,respectively) may be penetrated to facilitate closure of the opening intissue. Each of the respective sealing members 107, 108, 109, 160 (FIGS.25-28) is detailed, in turn, below.

As shown in FIG. 25, sealing member 107 is formed as a sleeve disposedabout a portion of elongated tubular member 102 a and is positioned soas to cover slots 106. Sealing member 107 may be formed from anysuitable flexible, penetrable material, e.g., rubber, PVC, etc., and maybe disposed about elongated tubular member 102 a via heat shrinkwrapping, overmolding, or any other suitable process. As shown in FIG.25, sealing member 107 substantially conforms to the exteriorconfiguration of elongated tubular member 102 a so as to maintain theribbed configuration of the exterior of elongated tubular member 102 a.

Referring to FIG. 26, sealing member 108 is similar to sealing member107 (FIG. 25) except that sealing member 108 is disposed about elongatedtubular member 102 a so as to define a substantially smooth exteriorsurface, e.g., without ribs. Sealing member 108 may be formed fromsimilar materials and/or may be disposed about elongated tubular member102 a similarly as detailed above with respect to sealing member 107(FIG. 25).

With reference to FIG. 27, sealing member 109 is similar to sealingmember 107 (FIG. 25) except that, rather than defining a sleeve disposedabout elongated tubular member 102 a, sealing member 109 includes a sealmember 109 a sealingly disposed over each of slots 106 and a pluralityof spaced-apart bands 109 b disposed about elongated tubular member 102a so as to maintain seal members 109 a in position about slots 106.Bands 109 b are disposed between the ribs defined on the exteriorsurface of elongated tubular member 102 a so as to maintain the ribbedconfiguration of elongated tubular member 102 a. Sealing member 109 maybe formed from similar materials and/or may be disposed about elongatedtubular member 102 a similarly as detailed above with respect to sealingmember 107 (FIG. 25). In some embodiments, bands 109 b are positionedsuch that seal members 109 a function as flaps, rather than beingconfigured to be penetrated by a suture passer. In such embodiments,bands 109 b bias seal members 109 a against elongated tubular member 102a so as to maintain a seal about slots 106 in the absence of a suturepasser. Upon insertion of a suture passer through one of the slots 106,the corresponding seal member 109 a is deflected to permit passage ofthe suture passer therethrough. Upon withdrawal of the suture passer,the seal member 109 a is returned to its biased position, once againsealing the slot 106.

As shown in FIG. 28, sealing member 160 is shown disposed about one ofthe slots 106 (FIGS. 5A-5B) defined through elongated tubular member 102a. Although only one of sealing members 160 is shown, it is envisionedthat a sealing member 160 be provided for sealing each of the slots 106(FIGS. 5A-5B) defined through elongated tubular member 102 a. Ratherthan being annularly disposed about elongated tubular member 102 a, eachsealing member 160 is localized about one of the slots 106 (FIGS.5A-5B), and is sealingly disposed thereabout via overmolding or othersuitable process. Sealing members 160 may be formed from any suitableflexible, penetrable material for this purpose, e.g., any of thematerials noted above.

Referring to FIGS. 6A-6B, another embodiment of a cannula configured foruse with surgical access assembly 10 (FIG. 1) is shown generally ascannula 200. Cannula 200 includes a housing having proximal and distalcomponents (not shown, similar to housing 110 of cannula 100 (FIGS.4A-4B)), and an elongated portion 202 extending distally from thehousing (not shown). Elongated portion 202 includes a base member 202 bconfigured to releasably receive the housing (not shown) and anelongated tubular member 202 a extending distally from base member 202b. Cannula 200 is similar to cannula 100 (FIGS. 4A-5B) and, thus, onlythe differences between cannula 200 and cannula 100 (FIGS. 4A-5B) willbe described in detail below for purposes of brevity.

Elongated tubular member 202 a of cannula 200 defines a longitudinalpassageway 205 extending therethrough and two pairs of offset slots 206a, 206 b extending through the annular side wall of elongated tubularmember 202 a, thus providing lateral access to and from longitudinalpassageway 205 to and from the exterior of elongated tubular member 202a. Each pair of slots 206 a, 206 b includes a more-proximally disposedslot and a more-distally disposed slot. The proximal and distal slots ofeach pair of slots 206 a, 206 b are diagonally offset from one another.More specifically, the proximal and distal slots of the first pair ofslots 206 a define a first slot axis “A-A” disposed at an oblique anglerelative to the longitudinal axis of cannula 200, while the proximal anddistal slots of the second pair of slots 206 b define a second,different slot axis “B-B” that is also disposed at an oblique anglerelative to the longitudinal axis of cannula 200, although these obliqueangles need not be the same. The pairs of slots 206 a, 206 b may bepositioned along the length of elongated tubular member 202 a in variousdifferent positions and/or multiple sets of paired slots 206 a, 206 bmay be provided, similarly as detailed above with respect to cannula 100(FIGS. 5A-5B). Elongated tubular member 202 a may further include one ormore penetrable sealing features, e.g., any of sealing members 107, 108,109, 160 (FIGS. 25-28, respectively), disposed about slots 206 a, 206 band/or elongated tubular member 202 a and configured to seal slots 206a, 206 b.

Detailed below with respect to FIGS. 7-14B are various embodiments ofguide members configured for use with surgical access assembly 10(FIG. 1) to facilitate closure of an opening in tissue after completionof one or more surgical tasks. More specifically, each of the guidemembers 300, 400, 500, 600 is configured for releasable engagementwithin cannula 100 (FIGS. 5A-5B) and/or cannula 200 (FIGS. 6A-6B) toguide passage of a suitable suture passer, e.g., suture passers 700,800, 900 (see FIGS. 15-22B), through tissue and into the internalsurgical site to deposit and/or retrieve a portion of a suture, thusfacilitating closing the opening in tissue. Each guide member 300, 400,500, 600 will be described in turn below. As can be appreciated, any orall of guide members 300, 400, 500, 600 may be provided for use inconjunction with either or both cannulas 100 and 200 (FIGS. 5A-5B and6A-6B, respectively), any of the other components of surgical accessassembly 10 (FIG. 1), and/or any of the suture passers 700, 800, 900(see FIGS. 15-22B) detailed below as part of a system or kit thatfacilitates accessing an internal surgical site through an opening intissue, performing one or more minimally-invasive surgical tasks withinthe internal surgical site, and closing the opening in tissue once thesurgical task(s) is complete. As an alternative to a suture passer,needles, wires, or other suitable instrument may also be used withrespect to any of the embodiments detailed herein for similar ordifferent purposes.

Turning to FIGS. 7-8B, one embodiment of a guide member configured foruse with cannula 100 and a suture passer, e.g., suture passer 700 or anyother suitable suture passer, for closing an opening in tissue is showngenerally identified by reference numeral 300. Guide member 300generally includes a guide housing 310 disposed in mechanicalcooperation with an elongated guide shaft 320. Guide member 300 furtherincludes a pair of guide lumens 316 a, 316 b extending therethrough.

Guide housing 310 defines a proximally-facing portion 311 including apair of recesses 312 that facilitate grasping and manipulation of guidemember 300 and a pair of apertures 314 a, 314 b that communicate withthe proximal ends of respective lumens 316 a, 316 b extending throughguide member 300. Guide housing 310 further includes threading 317defined on a distally-facing portion 315 thereof that is configured toengage complementary threading 129 of base member 102 b of cannula 100(see FIG. 4B), e.g., via a bayonet connection, to releasably engage andalign guide housing 310 and elongated portion 102 of cannula 100relative to one another, as detailed below.

Elongated guide shaft 320 of guide member 300 extends distally fromguide housing 310 and is configured for insertion through passageway 105(FIG. 5B) of elongated tubular member 102 a of cannula 100. Elongatedshaft 320 includes a pair of opposed slots 326 a, 326 b defined throughthe annular side wall of elongated shaft 320 that communicate with thedistal ends of respective lumens 316 a, 316 b extending through guidemember 300. That is, lumens 316 a, 316 b extend between respectiveapertures 314 a, 314 b defined through proximally-facing portion 311 ofguide housing 310 and respective slots 326 a, 326 b defined throughguide shaft 320. Each lumen 316 a, 316 b is curved to define a radius ofcurvature, and interconnects a respective aperture 314 a, 314 b with arespective slot 326 a, 326 b disposed on an opposite side of guidemember 300 (see, e.g., suture passer 700 in FIG. 7). As such, a suturepasser having a flexible shaft and/or a suture passer having acorresponding radius of curvature may be used in conjunction with guidemember 300. Further, lumens 316 a, 316 b are radially staggered relativeto one another such that, despite the fact that lumens 316 a, 316 bcross over one another, lumens 316 a, 316 b do not intersect oneanother.

Continuing with reference to FIGS. 7-8B, when using guide member 300with cannula 100, housing 110 of cannula 100 is first disengaged frombase member 102 b and removed. Thereafter, guide member 300 is insertedinto cannula 100 such that guide shaft 320 is advanced into elongatedtubular member 102 a and guide housing 310 is approximated relative tobase member 102 b. Upon sufficient insertion, guide member 300 may berotated relative to cannula 100 to engage threading 317 of guide member300 with complementary threading 129 of base member 102 b (see FIG. 4B)to both secure guide member 300 in position relative to cannula 100 andto align guide member 300 relative to cannula 100. Grasping and rotatingguide housing 310 to achieve this threaded engagement is facilitated byrecesses 312, as noted above. With guide member 300 and cannula 100properly aligned relative to one another, each slot 326 a, 326 b ofguide shaft 320 is aligned with one of the slots 106 defined throughelongated tubular member 102 a of cannula 100. As such, and as will bedetailed below, a suture passer, e.g., suture passer 700 or any othersuitable suture passer, may then be inserted through one of lumens 316a, 316 b of guide member 300, the corresponding slot 106 of cannula 100(penetrating the sealing member disposed thereabout), tissue, and intothe internal surgical site to facilitate closure of the opening intissue.

Turning to FIGS. 9-10C, another embodiment of a guide member configuredfor use with cannula 100 and a suture passer, e.g., suture passer 700 orany other suitable suture passer, for closing an opening in tissue isshown generally identified by reference numeral 400. Guide member 400generally includes a guide housing 410 disposed in mechanicalcooperation with an elongated guide shaft 420. Guide member 400 furtherincludes a pair of guide lumens 416 a, 416 b extending therethrough.

Guide housing 410 defines a proximally-facing portion 411 including apair of apertures 414 a, 414 b that communicate with the proximal endsof respective lumens 416 a, 416 b extending through guide member 400.Guide housing 410 further includes a pair of engagement tabs 417disposed on opposite sides of guide housing 410 and extending distallyfrom a distally-facing portion 415 of guide housing 410. Engagement tabs417 are configured for releasable engagement within the radially opposedapertures 111 defined though proximal housing component 110 a of housing110 of cannula 100 (see FIGS. 4A-4B) to permit releasable engagement andalignment of guide member 400 with cannula 100, as detailed below.

Elongated guide shaft 420 of guide member 400 extends distally fromguide housing 410 and is configured for insertion through passageway 105(FIG. 5B) of elongated tubular member 102 a of cannula 100. Elongatedshaft 420 includes a pair of opposed slots 426 a, 426 b defined throughthe annular side wall of elongated shaft 420 that communicate with thedistal ends of respective lumens 416 a, 416 b extending through guidemember 400. Lumens 416 a, 416 b of guide member 400 define a radius ofcurvature that is smaller than that of lumens 316 a, 316 b of guidemember 300 (see FIGS. 7-8B). This smaller radius of curvature is enabledby the fact that, different from guide member 300 (FIGS. 7-8B), eachlumen 416 a, 416 b interconnects a respective aperture 414 a, 414 b witha respective slot 426 a, 426 b disposed on the same side of guide member400 (see, e.g., suture passer 700 in FIG. 9). Accordingly, lumens 416 a,416 b do not intersect one another. Similarly as detailed above withrespect to guide member 300 (FIGS. 7-8B), a suture passer having aflexible shaft and/or a suture passer having a corresponding radius ofcurvature may be used in conjunction with guide member 400.

Continuing with reference to FIGS. 9-10C, when using guide member 400with cannula 100, guide member 400 is inserted into cannula 100 (withhousing 110 engaged to base member 102 b) such that guide shaft 420 isadvanced into elongated tubular member 102 a and guide housing 410 isapproximated relative to housing 110. Upon sufficient insertion, andwith proper alignment between guide member 400 and cannula 100,engagement tabs 417 of guide housing 410 are releasably engaged withinapertures 111 of proximal housing component 110 a of housing 110 ofcannula 100 to both secure guide member 400 in position relative tocannula 100 and to ensure and maintain alignment of guide member 400relative to cannula 100. With guide member 400 and cannula 100 properlyaligned relative to one another, each slot 426 a, 426 b of guide shaft420 is aligned with one of the slots 106 defined through elongatedtubular member 102 a of cannula 100. As such, a suture passer, e.g.,suture passer 700 or any other suitable suture passer, may be insertedthrough one of lumens 416 a, 416 b of guide member 400, thecorresponding slot 106 of cannula 100 (penetrating the sealing memberdisposed thereabout), tissue, and into the internal surgical site tofacilitate closure of the opening in tissue.

Turning to FIGS. 11-12B, another embodiment of a guide member configuredfor use with cannula 100 and a suture passer, e.g., suture passer 700 orany other suitable suture passer, for closing an opening in tissue isshown generally identified by reference numeral 500. Guide member 500generally includes a guide housing 510 disposed in mechanicalcooperation with an elongated guide shaft 520. Guide member 500 furtherincludes a pair of guide lumens 516 a, 516 b extending betweenrespective apertures 514 a, 514 b defined through guide housing 510 andrespective slots 526 a, 526 b defined through guide shaft 520. Guidemember 500 is similar to guide member 400 (FIGS. 9-10C) except thatlumens 516 a, 516 b of guide member 500 do not define radii of curvaturebut, rather, define curved configurations that vary in degree ofcurvature along the length of lumens 516 a, 516 b, e.g., lumens 516 a,516 b define “J”-shaped configurations. More specifically, the proximalportions of lumens 516 a, 516 b define a lesser degree of curvature,thus enabling insertion of suture passer 700 therethrough insubstantially parallel alignment with the longitudinal axis of guidemember 500 (see, e.g., FIG. 11), while the distal portions of lumens 516a, 516 b define a greater degree of curvature to route suture passer 700therethrough at an appropriate angle relative to tissue (see, e.g., FIG.11). As such, guide member 500 is configured for use with a suturepasser having a flexible shaft that enables the suture passer to conformto the varying curvature of lumens 516 a, 516 b upon insertiontherethrough.

Referring to FIGS. 13-14B, another embodiment of a guide member providedin accordance with the present disclosure is shown generally identifiedby reference numeral 600. Guide member 600 is configured for use withcannula 200 and a suture passer, e.g., suture passer 700 or any othersuitable suture passer, for closing an opening in tissue. Guide member600 generally includes a guide housing 610 disposed in mechanicalcooperation with an elongated guide shaft 620.

Guide housing 610 includes a pair of engagement tabs 617 disposed onopposite sides of guide housing 610 and extending therefrom. Engagementtabs 617, similarly as detailed above with respect to guide member 400(FIGS. 9-10C), are configured for releasable engagement within radiallyopposed apertures 211 defined though proximal housing component 210 a ofhousing 210 of cannula 200 to permit releasable engagement and alignmentof guide member 600 with cannula 200.

Elongated guide shaft 620 of guide member 600 extends distally fromguide housing 610 and is configured for insertion through passageway 205(FIG. 6B) of elongated tubular member 202 a of cannula 200. Elongatedshaft 620 includes a pair of angled lumens 626 a, 626 b extendingtherethrough. Although lumens 626 a, 626 b cross over one another,lumens 626 a, 626 b are radially staggered relative to one another suchthat lumens 626 a, 626 b do not intersect. Upon insertion and engagementof guide member 600 within cannula 200, angled lumens 626 a, 626 b arealigned with first and second slot axes “A-A,” “B-B,” respectively (seeFIG. 6A). That is, angled lumens 626 a, 626 b are disposed between theproximal and distal slots of respective pairs of slots 206 a, 206 b. Assuch, a suture passer, e.g., suture passer 700 or any other suitablesuture passer, may be inserted through the proximal slot of either ofthe pairs of slots 206 a, 206 b (penetrating the sealing member disposedthereabout), the corresponding lumen 616 a, 616 b, the distal slot ofthe corresponding pair of slots 206 a, 206 b (penetrating the sealingmember disposed thereabout), tissue, and into the internal surgical siteto facilitate closure of the opening in tissue.

With reference to FIGS. 15-16B, suture passer 700 is described. As notedabove, suture passer 700 may be configured for use with any or all ofguide members 300, 400, 500, 600 (FIGS. 7-14B). Suture passer 700generally includes a handle 710, an elongated sleeve 720, an inner shaft730, an end effector assembly 740, and a plunger 750. Elongated sleeve720 and inner shaft 730 are both flexible to permit insertion throughany of the lumens of guide members 300, 400, 500, 600 (FIGS. 7-14).Alternatively, elongated sleeve 720 and inner shaft 730 may definerigid, curved configurations have a radius of curvature equal to that ofthe lumens of guide member 300 or guide member 400 (FIGS. 78B and 9-10C,respectively) for use therewith, or may define rigid, linearconfigurations. Further, elongated sleeve 720 defines a distal tip 722configured to facilitate penetration of elongated sleeve 720 throughtissue (and through the sealing member(s) of cannula 100). Distal tip722 may define a sharpened configuration or may define a bluntconfiguration.

Elongated sleeve 720 of suture passer 700 is fixed relative to handle710 and extends distally from handle 710. Inner shaft 730 is slidablydisposed within elongated sleeve 720 and is coupled to plunger 750within handle 710. As such, inner shaft 730 is selectively slidablerelative to handle 710 and elongated sleeve 720 upon manual translationof plunger 750 relative to handle 710 between a retracted position (FIG.16A) and an extended position (FIG. 16B). A biasing member (not shown)may be provided for biasing inner shaft 730 towards the retractedposition (FIG. 16A).

End effector assembly 740 is disposed at the distal end of inner shaft730 and includes a pair of spring arms 742, 744 extending from thedistal end of inner shaft 730. Spring arms 742, 744 are biased towards aspaced-apart position relative to one another and define bent fingers743, 745 at the respective free ends thereof. In the retracted positionof inner shaft 730, spring arms 742, 744 are retained within theinterior of elongated sleeve 720 such that spring arms 742, 744 aredisposed in close approximation with each other and fingers 743, 745 atleast partially overlap each other. This position corresponds to theinsertion/withdrawal condition of suture passer 700, wherein a portionof suture disposed between spring arms 742, 744 is retained therebetweenfor insertion into and/or withdrawal from the internal surgical site andwherein distal tip 722 of elongated sleeve 720 is exposed to facilitatetissue penetration. In the extended position of inner shaft 730 (FIG.16B), spring arms 742, 744 extend distally from elongated sleeve suchthat spring arms 742, 744 are uninhibited by elongated sleeve 720, thuspermitting spring arms 742, 744 to achieve the spaced-apart positioncorresponding to a deployed condition of suture passer 700. In thisdeployed condition, end effector assembly 740 may be manipulated intoposition such that a portion of suture to be grasped is positionedbetween spring arms 742, 744. Once this position has been achieved,plunger 750 may be grasped and translated proximally relative to handle710 to translate inner shaft 730 proximally relative to elongated sleeve720 from the extended position (FIG. 16B) back to the retracted position(FIG. 16A).

As an alternative to elongated sleeve 720 being fixed relative to handle710 and inner shaft 730 being selectively slidable relative to handle710 and elongated sleeve 720 to transition suture passer 700 between theinsertion/withdrawal condition and the deployed condition, thisconfiguration may be reversed. That is, inner shaft 730 may be fixedrelative to handle 710 and plunger 750 may be coupled to elongatedsleeve 720 such that manual translation of plunger 750 relative tohandle 710 effects translation of elongated sleeve 720 relative tohandle 710 and inner shaft 730 between the position shown in FIG. 16A,wherein spring arms 742, 744 are retained within the interior ofelongated sleeve 720, and the position shown in FIG. 16B, wherein springarms 742, 744 are permitted to achieve the spaced-apart position.

With reference to FIGS. 17A-19B, another embodiment of a suture passer800 configured for use with any or all of guide members 300, 400, 500,600 (FIGS. 7-14B) is described. As detailed below, suture passer 800 istransitionable between an insertion/withdrawal condition (FIGS.17A-17B), a piercing condition (FIGS. 18A-18B), and a deployed condition(FIGS. 19A-19B). Suture passer 800 generally includes a handle 810, anelongated sleeve 820, an inner shaft 830, an end effector assembly 840,and a plunger 850. Elongated sleeve 820 and inner shaft 830 are bothflexible to permit insertion through any of the lumens of guide members300, 400, 500, 600 (FIGS. 7-14). Alternatively, elongated sleeve 820 andinner shaft 830 may define rigid, curved configurations having a radiusof curvature equal to that of the lumens of guide member 300 or guidemember 400 (FIGS. 7-8B and 9-10C, respectively) for use therewith, ormay define rigid, linear configurations.

Elongated sleeve 820 of suture passer 800 is fixed within handle 810 viaa bushing 822 and extends distally from handle 810. Elongated sleeve 820defines a sharpened distal tip 824 configured to facilitate piercingtissue upon advancement of elongated sleeve 820 through tissue (and forpenetrating the sealing members of cannula 100 (FIGS. 5A-5B)), althoughdistal tip 824 may alternatively define a blunt configuration.

Inner shaft 830 of suture passer 800 is slidably disposed withinelongated sleeve 820 and a longitudinal lumen 812 extending throughhandle 810. Longitudinal lumen 812 includes first and second chambers814, 816. First chamber 814 is configured to slidably receive a distalportion of plunger 850 to permit longitudinal reciprocation of plunger850 relative to handle 810 between a proximal position (FIG. 18A), anintermediate position (FIG. 17A) and a distal position (FIG. 19A). Thedistal end of plunger 850 is engaged to the proximal end of inner shaft830 such that reciprocation of plunger 850 relative to handle 810translates inner shaft 830 through and relative to handle 810 andelongated sleeve 820.

A biasing assembly 860 is disposed within second chamber 816 oflongitudinal lumen 812 of handle 810 of suture passer 800. Biasingassembly 860 includes a cartridge 862, a first biasing member 864, and asecond biasing member 866. Cartridge 862 is slidably disposed aboutinner shaft 830 and slidably disposed within second chamber 816. Firstbiasing member 864 is disposed about inner shaft 830 within cartridge862 and is fixed to inner shaft 830 at a proximal end of first biasingmember 864 via a collar 865. Second biasing member 866 is disposed aboutinner shaft 830 within second chamber 816 between the proximal end ofsecond chamber 816 and cartridge 862. As a result of this configuration,biasing assembly 860 biases suture passer 800 towards theinsertion/withdrawal condition (FIGS. 17A-17B).

End effector assembly 840 is disposed at the distal end of inner shaft830 and includes a receiver shaft 842 and a spring arm 844. Receivershaft 842 defines a semi-cylindrical hollow interior that is configuredto receive spring arm 844 in the insertion/withdrawal and piercingconditions of suture passer 800 (FIGS. 17B and 18B, respectively).Receiver shaft 842 further includes a distal cap 846 disposed at adistal end thereof. Distal cap 846 defines a blunt distal end 847 andproximally-facing hook-shaped cut-outs 848 on each side thereof that areconfigured to receive a portion of suture therein. Spring arm 844 isbiased towards a spaced-apart position relative to receiver shaft 842corresponding to the deployed condition (FIG. 19B) of suture passer 800.Upon proximal retraction of end effector assembly 840 into elongatedsleeve 820, spring arm 844 is urged via camming engagement withelongated sleeve 820 towards an approximated position wherein spring arm844 is disposed within the hollow interior of receiver shaft 842 and thedistal end of spring arm 844 is positioned within distal cap 846 ofreceiver shaft 842. Spring arm 844 is disposed in this approximatedposition in both the piercing condition (FIG. 18B) and theinsertion/withdrawal condition (FIG. 17B) of suture passer 800.

In use, with reference to FIGS. 17A-17B, suture passer 800 is initiallydisposed, at-rest, in the insertion/withdrawal condition, wherein endeffector assembly 840 extends distally from distal tip 824 of elongatedsleeve 820 so as to inhibit distal tip 824 from inadvertently piercing,catching, or otherwise causing damage. In the insertion/withdrawalcondition of suture passer 800, plunger 850 is disposed in theintermediate position. As detailed above, in the insertion/withdrawalcondition, spring arm 844 is disposed in the approximated positionwithin the hollow interior of receiver shaft 842. Depending on aparticular purpose, a portion of suture may be disposed withinhook-shaped cut-outs 848 of receiver shaft 842 for insertion throughtissue and into the internal surgical site. Alternatively, where aportion of suture is to be retrieved, suture passer 800 may remainempty.

Referring additionally to FIGS. 18A-18B, with suture passer 800 disposedin the insertion/withdrawal condition (FIGS. 17A-17B), suture passer 800may be inserted through a lumen of a guide member, e.g., any of guidemembers 300, 400, 500, 600 (FIGS. 7-14), and into contact with tissuesurrounding the opening. Upon contacting tissue, the resistance force oftissue acting on suture passer 800 urges end effector assembly 840proximally relative to elongated sleeve 820 against the bias of secondbiasing member 866 such that end effector assembly 840 is pushed intoelongated sleeve 820 to expose distal tip 824 of elongated sleeve 820.As end effector assembly 840 is pushed proximally into elongated sleeve820, inner shaft 830 and plunger 850 are also translated proximally suchthat plunger 850 is moved to the proximal position. This position of endeffector assembly 840 corresponds to the piercing condition of suturepasser 800 (FIG. 18A-18B). Thus, upon further advancement of suturepasser 800 though tissue, distal tip 824 facilitates the piercing oftissue. Upon reaching the internal surgical site, e.g., once tissue isno longer providing a suitable resistance force, suture passer 800 isreturned under the bias of second biasing member 866 to the at-rest,insertion/withdrawal condition (FIGS. 17A-17B), wherein end effectorassembly 840 extends distally from distal tip 824 of elongated sleeve820 so as to inhibit distal tip 824 from inadvertently piercing,catching, or otherwise causing damage. As noted above, plunger 850 isdisposed in the intermediate position in the insertion/withdrawalcondition of suture passer 800 (FIGS. 17A-17B).

With additional reference to FIGS. 19A-19B, once suture passer 800 hasbeen inserted through the guide member, tissue, and into the internalsurgical site, suture passer 800 may be transitioned from theinsertion/withdrawal condition (FIGS. 17A-17B) to the deployed condition(FIGS. 19A-19B) by translating plunger 850 distally relative to handle810 from the intermediate position to the distal position against thebias of first biasing member 864. Translating plunger 850 to the distalposition extends end effector assembly 840 from elongated sleeve 820such that spring arm 844 is permitted to return under bias to thespaced-apart position relative to receiver shaft 842, corresponding tothe deployed condition of suture passer 800. In this position, suturepasser 800 may be manipulated to release a portion of suture retainedvia end effector assembly 840 or to position a portion of suture to beretrieved between receiver shaft 842 and spring arm 844. Thereafter,plunger 850 may be released to allow suture passer 800 to return underbias to the insertion/withdrawal condition (FIGS. 17A-17B), whereinspring arm 844 is approximated within the hollow interior of receivershaft 842. Where a portion of suture is to be retrieved, transitioningsuture passer 800 back to the insertion/withdrawal condition (FIGS.17A-17B) and withdrawing suture passer 800 urges the portion of sutureinto hook-shaped cut-outs 848 to permit withdrawal of the portion ofsuture along with suture passer 800.

With reference to FIGS. 20A-22B, another embodiment of a suture passer900 configured for use with any or all of guide members 300, 400, 500,600 (FIGS. 7-14B) is described. As detailed below, suture passer 900 istransitionable between a deployed condition (FIGS. 20A-20B), aninsertion/withdrawal condition (FIGS. 21A-21B), and a piercing condition(FIGS. 22A-22B). Suture passer 900 generally includes a handle 910, afixed sleeve 920, a movable sleeve 925, an inner shaft 930, an endeffector assembly 940, a plunger assembly 950, a biasing assembly 960,and a release assembly 970. Fixed sleeve 920, movable sleeve 925, andinner shaft 930 are flexible to permit insertion through any of thelumens of guide members 300, 400, 500, 600 (FIGS. 7-14). Alternatively,these components may define rigid, curved configurations having a radiusof curvature equal to that of the lumens of guide member 300 or guidemember 400 (FIGS. 7-8B and 9-10C, respectively) for use therewith, ormay define rigid, linear configurations.

Fixed sleeve 920 of suture passer 900 is fixed within handle 910 via abushing 922 and extends distally from handle 910. Movable sleeve 925 isslidable disposed within fixed sleeve 920 and a lumen 912 definedthrough handle 910. Movable sleeve 925 extends distally from fixedsleeve 920 and is slidable relative thereto to vary the amount movablesleeve 925 extends from fixed sleeve 920 (see FIG. 20B). Fixed sleeve920 (see FIG. 20B) serves as a barrier to inhibit contact betweenmovable sleeve 925 and surgical instrumentation (not shown) and/ortissue through which suture passer 900 is inserted, thus inhibitingrubbing or catching of movable sleeve 925 upon translation relative tothe surgical instrumentation (not shown) and/or tissue. Movable sleeve925 defines a blunt distal end 927 and is coupled to plunger assembly950 within handle 910 via a ferrule 929 disposed at the proximal endthereof, as detailed below.

Inner shaft 930 of suture passer 900 extends distally from lumen 912 ofhandle 910 through movable sleeve 925. Inner shaft 930 is fixed tohandle 910 at its proximal end via a pin 932, although other securementmechanisms are also contemplated. End effector assembly 940 is disposedat the distal end of inner shaft 930 and includes a receiver shaft 942and a spring arm 944. Receiver shaft 942 defines a semi-cylindricalhollow interior that is configured to receive spring arm 944 in both theinsertion/withdrawal condition (FIGS. 21A-21B) and the piercingcondition (FIGS. 22A-22B) of suture passer 900. Receiver shaft 942further includes a distal cap 946 disposed at a distal end thereof.Distal cap 946 defines a sharpened or pointed distal piercing tip 947configured to facilitate piercing through tissue (and the sealingmembers of cannula 100 (FIGS. 5A-5B)), and proximally-facing hook-shapedcut-outs 948 on each side thereof that are configured to receive aportion of suture therein. Spring arm 944 is biased towards aspaced-apart position relative to receiver shaft 942 corresponding tothe deployed condition (FIG. 20B) of suture passer 900. Upon distalextension of movable sleeve 925 about end effector assembly 940, asdetailed below, spring arm 944 is urged via camming engagement withmovable sleeve 925 towards an approximated position wherein spring arm944 is disposed within the hollow interior of receiver shaft 942 and thedistal end of spring arm 944 is positioned within distal cap 946 ofreceiver shaft 942. Spring arm 944 is disposed in this approximatedposition in both the insertion/withdrawal condition (FIGS. 21A-21B), andthe piercing condition (FIGS. 22A-22B) of suture passer 900.

Plunger assembly 950 includes a plunger member 952 slidably disposedwithin a chamber 913 of lumen 912 of handle 910. Plunger member 952includes a proximal shaft 954 that extends proximally from handle 910 toenable manual depression of proximal shaft 954 into handle 910, alocking component 956 configured to substantially lock suture passer 900in the insertion/withdrawal condition (FIGS. 21A-21B), and a distalcartridge 958 disposed about ferrule 929 of movable shaft 925. Lockingcomponent 956 interconnects proximal shaft 954 and distal cartridge 958.Plunger member 952 may be formed as a monolithic component or thecomponents thereof may otherwise be secured to each other in anysuitable fashion. Locking component 956 of plunger member 952 includesfirst and second spring legs 957 a, 957 b each including an engagementtoe 957 c, 957 d, respectively, disposed at the free end thereof. Asdetailed below, engagement toes 957 c, 957 d are configured to abutshoulders 914, 915 defined within handle 910 to inhibit further proximaltravel of plunger member 952 relative to handle 910, and to spring intoengagement within slots 916, 917 defined through handle 910 tosubstantially lock suture passer 900 in the insertion/withdrawalcondition (FIGS. 21A-21B).

Biasing assembly 960 is disposed within chamber 913 of lumen 912 ofhandle 910 and includes a first biasing member 964 and a second biasingmember 966. First biasing member 964 is disposed within distal cartridge958 of plunger assembly 950 between the proximal end of distal cartridge958 and ferrule 929, which is disposed at the proximal end of movablesleeve 925. As such, plunger member 952 is operably coupled to movablesleeve 925 to effect translation thereof upon translation of plungermember 952 in a similar direction. However, this coupling also providesa degree of play, that is, movable sleeve 925 is translatable relativeto plunger member 952 via movement of ferrule 929 within distalcartridge 958, e.g., under or against the bias of first biasing member964. Second biasing member 966 is disposed about movable sleeve 925between distal cartridge 958 and the distal end of chamber 913 of lumen912 so as to bias plunger member 952 proximally.

Release assembly 970 includes a pair of opposed release members 972, 974slidably disposed within respective slots 916, 917 defined throughhandle 910. Release members 972, 974 are movable relative to handle 910between an initial position (FIG. 20A), wherein release members 972, 974extend only partially into slots 916, 917, respectively, and a releaseposition (not shown), wherein release member 972, 974 extend furtherinto slots 916, 917, respectively to ultimately contact respectiveengagement toes 957 c, 957 d and urge respective engagement toes 957 c,957 d out of engagement with respective slots 916, 917 to unlock suturepasser 900 from the insertion/withdrawal condition (FIGS. 21A-21B), asdetailed below. Biasing members (not shown) may be provided for biasingrelease members 972, 974 towards the initial position, although otherconfigurations are also contemplated.

In use, initially referring to FIGS. 20A-20B, suture passer 900 isdisposed in the deployed condition, wherein movable shaft 925 isproximally spaced from end effector assembly 940 such that spring arm944 of end effector assembly 940 is disposed in the spaced-apartposition relative to receiver shaft 942. As such, a portion of suturemay be positioned within or removed from end effector assembly 940,similarly as detailed above with respect to suture passer 800 (FIGS.17A-19B). In the deployed condition, plunger member 952 is biasedproximally by second biasing member 966 such that engagement toes 957 c,957 d abut shoulders 914, 915 defined within handle 910, therebyinhibiting plunger member 952 from translating further proximallyrelative to handle 910. At this point, release members 972, 974 remaindisposed in the initial position.

With additional reference to FIGS. 21A-21B, in order to prepare suturepasser 900 for insertion, suture passer 900 is transitioned to theinsertion/withdrawal condition by depressing or translating plungermember 952 distally relative to handle 910. Distal translation ofplunger member 952 relative to handle 910 translates movable sleeve 925distally about and relative to inner shaft 930 and end effector assembly940 such that movable sleeve 925 urges spring arm 944 to theapproximated position and, ultimately, fully encloses end effectorassembly 940. By fully enclosing end effector assembly 940, distalpiercing tip 947 of end effector assembly 940 is inhibited frominadvertently piercing, catching, or otherwise causing damage.Concomitantly with the distal translation of movable sleeve 925, lockingcomponent 956 of plunger member 952 is translated distally, ultimatelysuch that engagement toes 957 c, 957 d are positioned adjacentrespective slots 916, 917 of handle 910, thus permitting engagement toes957 c, 957 d to spring into engagement within slots 916, 917. Plungermember 952 may then be released as the engagement of engagement toes 957c, 957 d within slots 916, 917 substantially locks suture passer 900 inthe insertion/withdrawal condition (FIGS. 21A-21B). Suture passer 900 isonly substantially locked in the insertion/withdrawal condition (FIGS.21A-21B) since movable sleeve 925 is still translatable relative toplunger member 952 via movement of ferrule 929 within distal cartridge958. The importance of this feature is detailed below.

Referring additionally to FIGS. 22A-22B, with suture passer 900 disposedin the insertion/withdrawal condition (FIGS. 21A-21B), suture passer 900may be inserted through a lumen of a guide member, e.g., any of guidemembers 300, 400, 500, 600 (FIGS. 7-14), and into contact with tissuesurrounding the opening. Upon contacting tissue, the resistance force oftissue acting on suture passer 900 urges movable sleeve 925 proximallyrelative to end effector assembly 940 against the bias of first biasingmember 964 such that distal piercing tip 947 of end effector assembly940 is at least partially exposed, corresponding to the piercingcondition of suture passer 900 (FIGS. 22A-22B). This movement ispermitted by the play provided in the coupling between distal cartridge985 of plunger member 952 and ferrule 929 of movable sleeve 925. Withdistal piercing tip 947 of end effector assembly 940 exposed,advancement of suture passer 900 though tissue can be more readilyachieved. Upon reaching the internal surgical site, e.g., once tissue isno longer providing a suitable resistance force, suture passer 900 isreturned under the bias of first biasing member 964 to theinsertion/withdrawal condition (FIGS. 21A-21B), wherein movable sleeve925 once again encloses end effector assembly 940 so as to inhibitdistal piercing tip 947 of end effector assembly 940 from inadvertentlypiercing, catching, or otherwise causing damage.

Once suture passer 900 has been inserted through the guide member,tissue, and into the internal surgical site, suture passer 900 may bereturned to the deployed condition (FIGS. 20A-20B) by squeezing releasemembers 972, 974 inwardly relative to handle 910 such that releasemembers 972, 974 are advanced further into slots 916, 917, respectively,to urge engagement toes 957 c, 957 d, respectively, out of engagementwith respective slots 916, 917, thereby unlocking suture passer 900 fromthe insertion/withdrawal condition (FIGS. 21A-21B) and permitting suturepasser 900 to return to the deployed position (FIGS. 20A-20B) under thebias of second biasing member 966. In the deployed position, a portionof suture may be positioned within or removed from end effector assembly940, similarly as detailed above with respect to suture passer 800(FIGS. 17A-19B). Ultimately, suture passer 900 may be returned to theinsertion/withdrawal condition (FIGS. 21A-21B) as detailed above, andwithdrawn from the internal surgical site.

Any of the above-detailed suture passers may further include one or moreflush ports to enable flush-cleaning of the interior of the suturepasser. Further, seals may be provided on or within the suture passersto separate the insertable portions from the handle or exteriorportions, thus helping to contain contaminants, e.g., tissue, blood,fluids, and/or debris, to limited portions of the suture passer tofacilitate cleaning. The suture passers may additionally oralternatively be configured for selective disassembly (and be made ofsterilizable reusable and/or disposable components) to facilitatecleaning and/or replacement of disposable components. Likewise, theinternal working components disposed within the handles of the suturepassers may be exposed, e.g., via windows, openings, and/or cut-outs inthe handles, to facilitate cleaning.

As can be appreciated, the various cannulas, guide members, and suturepassers detailed above, to the extent compatible with one another, canbe utilized in any suitable combination with obturator 11 (FIG. 2) orother suitable obturator to access an internal surgical site through anopening in tissue, perform one or more minimally-invasive surgical taskswithin the internal surgical site (under insufflation if required), andclose the opening in tissue once the surgical task(s) is complete.Alternatively, any of the guide members may incorporate the features ofobturator 11 (FIG. 2), e.g., an atraumatic guiding nub 26 (FIG. 2), and,thus, may function as both the obturator and the guide member, obviatingthe need for a separate obturator. In use, the cannula and obturator (orguide member, in embodiments where the guide member also functions asthe obturator) are first utilized to create and/or expand the opening intissue and for positioning the cannula therein; the cannula, afterwithdrawal of the obturator (or guide member), is utilized to protectsurrounding tissue, maintain insufflation, and/or guide surgicalinstrumentation (not shown) into the internal surgical site; the guidemember is inserted into the cannula to and utilized to facilitateinsertion and withdrawal of one of the suture passers through tissueadjacent the opening; and the suture passers are utilized to depositand/or retrieve a portion of suture to/from the internal surgical siteon either side of the opening in tissue to enable tying off of thesuture to close the opening.

Any suitable suture or sutures may be utilized in conjunction with theabove. In particular, the suture(s) may be provided in any suitable formand/or include any suitable feature(s) to facilitate insertion throughand depositing the suture within the internal surgical site on one sideof the opening in tissue, and retrieval and withdrawal of the portion ofsuture from the other side of the opening in tissue. Such aconfiguration establishes a “U”-shaped suture extending through tissueon either side of the opening and across the opening on the internalside of tissue. This configuration enables tying off of theexternally-disposed free ends of the suture and provides sufficientholding strength to permit healing and resist re-opening of the suturedtissue. One particular embodiment of a suture retention and positioningmember is detailed below with respect to FIGS. 23-24E.

Turning to FIGS. 23-24E, another embodiment of a guide member configuredfor use with cannula 100 and a suture passer, e.g., any of the suturepassers detailed above or any other suitable suture passer, for closingan opening in tissue is shown generally identified by reference numeral1000. As can be appreciated, guide member 1000 may alternatively beconfigured for use with cannula 200 (FIGS. 6A-6B). Guide member 1000generally includes a guide housing 1010 disposed in mechanicalcooperation with an elongated guide shaft 1020, and a suture retentionand positioning member 1030 disposed at a distal end of elongated guideshaft 1020. Suture retention and positioning member 1030 may bepermanently affixed to elongated guide shaft 1020 or may be releasablycoupled thereto, e.g., via friction-fitting or other suitable releasableengagement. In embodiments where suture retention and positioning member1030 is removable, suture retention and positioning member 1030 maysimilarly be coupled to any of the other guide members detailed hereinfor similar use therewith.

Guide housing 1010 and elongated guide shaft 1020 of guide member 1000may be configured similar to any of the embodiments detailed above. Thatis, elongated guide shaft 1020 and/or guide housing 1010 may definelumens extending therethrough of any suitable configuration for routinga suture passer through guide member 1000, cannula 100, and tissue,similarly as detailed above. Guide housing 1010 further includesengagement tabs 1017 extending therefrom that are configured forreleasable engagement within the radially opposed apertures 111 definedthough proximal housing component 110 a of housing 110 of cannula 100(see FIGS. 4A-4B) to permit releasable engagement and alignment of guidemember 1000 with cannula 100, similarly as detailed above.Alternatively, guide housing 1010 may include threading configured toengage base member 102 b of cannula 100 (with housing 110 removedtherefrom), as also detailed above. As these features are detailed abovewith respect to the other embodiments of guide members, they will not berepeated below.

Suture retention and positioning member 1030 includes a body portion1032 disposed about the distal end of elongated guide shaft 1020 andfirst and second flexible arms 1034, 1036 extending from either side ofbody portion 1032. Arms 1034, 1036 are monolithically formed with bodyportion 1032 (or otherwise engaged thereto) to define living hinges (orother suitable hinge structure) therebetween, thus permitting arms 1034,1036 to bend or flex relative to body portion 1032. Each arm 1034, 1036further includes a slot (not explicitly shown) defined therein towardsthe free end thereof that is configured to frictionally retain a portionof a suture “S” therebetween. As shown in FIG. 23, suture “S” extendsbetween the free ends of arms 1034, 1036. Further, arms 1034, 1036, atrest, define pre-bent configurations wherein the free ends of arms 1034,1036 are curved proximally towards guide member 1000. As a result ofthis configuration, the portion of suture “S” extending between the freeends of arms 1034, 1036 is spaced-apart from arms 1034, 1036,facilitating the grasping of suture “S.” This configuration alsofacilitates insertion of guide member 1000 into cannula 100, as detailedbelow. Suture “S” defines sufficient length so as to enable suture “S”to extend across the opening on the internal side of tissue, through theopening in tissue on either side thereof, and proximally from tissuesufficiently so as to enable tying off of the suture “S.” Theintermediate portion of suture “S” may be adhered, tacked, or otherwisestored within or on suture retention and positioning member 1030 duringinsertion of guide member 1000.

Turning now to FIGS. 24A-24E, the use of guide member 1000 inconjunction with cannula 100 is detailed. Initially, as shown in FIGS.24A-C, guide member 1000, lead by suture retention and positioningmember 1030 is inserted into cannula 100. As guide member 1000 isinserted into cannula 100, arms 1034, 1036 of suture retention andpositioning member 1030 are flexed inwardly towards elongated guideshaft 1020 to permit insertion through cannula 100.

Referring to FIG. 24D, guide member 1000 is further inserted intocannula 100 until arms 1034, 1036 of suture retention and positioningmember 1030 emerge from the distal end of cannula 100 and engagementtabs 1017 are engaged with apertures 111 to engage and align guidemember 1000 with cannula 100. In this fully inserted position, arms1034, 1036 are permitted to return to their at-rest positions such thata portion of suture “S” is presented on either side of cannula 100. Thepresented portions of suture “S” are operably positioned to enablegrasping by a suture passer inserted through cannula 100 and guidemember 1000. More specifically, a suture passer may be inserted throughguide member 1000, cannula 100, and tissue on a first side of theopening in tissue to grasp a first portion of suture “S” and withdrawthe first portion of suture “S” through tissue on the first side of theopening, followed by the suture passer being inserted through guidemember 1000, cannula 100, and tissue on a second, opposite side of theopening in tissue to grasp a second portion of suture “S” and withdrawthe second portion of suture “S” through tissue on the second side ofthe opening.

With reference to FIG. 24E, once the first and second portions of suture“S” have been retrieved on either side of the opening, as detailedabove, guide member 1000 may be withdrawn from cannula 100. In order towithdraw guide member 1000, guide housing 1010 is grasped and translatedproximally with sufficient force so as to disengage engagement tabs 1017from apertures 111 and to flex arms 1034, 1036 distally and intoapproximation with one another so as to allow suture retention andpositioning member 1030 to pass proximally through cannula 100. Onceguide member 1000 has been removed, cannula 100 may likewise be removedand the first and second portions of suture “S” tied off to close theopening in tissue.

Turning now to FIGS. 29-30C, another embodiment of a guide memberconfigured for use with cannula 100 and a suture passer, e.g., any ofthe suture passers detailed above or any other suitable suture passer,for closing an opening in tissue is shown generally identified byreference numeral 1100. As can be appreciated, guide member 1100 mayalternatively be configured for use with cannula 200 (FIGS. 6A and 6B).Guide member 1100 generally includes a guide housing 1110 disposed inmechanical cooperation with an elongated guide shaft 1120, and acleaning member 1130 disposed towards a distal end of elongated guideshaft 1120. Cleaning member 1130 may be permanently affixed to elongatedguide shaft 1120 or may be releasably coupled thereto. In embodimentswhere cleaning member 1130 is removable, cleaning member 1130 maysimilarly be coupled to any of the other guide members detailed hereinfor similar use therewith.

Guide housing 1110 and elongated guide shaft 1120 of guide member 1100may be configured similar to any of the embodiments detailed above. Thatis, elongated guide shaft 1120 and/or guide housing 1110 may definelumens extending therethrough of any suitable configuration for routinga suture passer through guide member 1100, cannula 100, and tissue,similarly as detailed above. Guide housing 1110 further includesengagement tabs 1117 extending therefrom that are configured forreleasable engagement within the radially opposed apertures 111 definedthough proximal housing component 110 a of housing 110 of cannula 100(see FIGS. 4A and 4B) to permit releasable engagement and alignment ofguide member 1100 with cannula 100, similarly as detailed above.Alternatively, guide housing 1110 may include bayonet fitting configuredto engage base member 102 b of cannula 100 (with housing 110 removedtherefrom), as also detailed above. As these features are detailed abovewith respect to the other embodiments of guide members, they will not berepeated below.

Referring to FIG. 29, cleaning member 1130 is generally annular in shapeand, as mentioned above, is positioned about elongated guide shaft 1120towards the distal end thereof. Cleaning member 1130 may be formed fromany suitable resiliently compressible material, e.g., biocompatiblefoam, and defines a bulbous configuration such that cleaning member 1130bulges radially outwardly from the outer annular surface of elongatedguide shaft 1120. Cleaning member 1130 defines a maximum diameter, inits at-rest position, that is greater than the diameter of longitudinalpassageway 105 of elongated tubular member 102 a of cannula 100 (seeFIG. 30B). Cleaning member 1130 is resiliently compressible from thisat-rest position to a compressed position, wherein cleaning member 1130defines a minimum diameter that is less than or equal to the diameter oflongitudinal passageway 105 of elongated tubular member 102 a of cannula100 (see FIG. 30B).

With reference to FIGS. 30A and 30B, in use, guide member 1100 isinserted through longitudinal passageway 105 of elongated tubular member102 a of cannula 100, similarly as detailed above with respect to theprevious guide members. As guide member 1100 is initially insertedthrough longitudinal passageway 105 of elongated tubular member 102,cleaning member 1130 is sufficiently compressed to permit insertionthrough longitudinal passageway 105 while also being resiliently biasedinto contact with the interior surface of elongated tubular member 102 athat surrounds longitudinal passageway 105. As a result, duringinsertion, cleaning member 1130 wipes the interior surface of elongatedtubular member 102 a to remove fluids, debris, tissue, etc. therefrom.In addition to being resiliently compressible, cleaning member 1130 mayfurther be absorbent and/or may otherwise be configured to facilitatewiping and cleaning the interior surface of elongated tubular member 102a during translation of guide member 1100 therethrough.

It is envisioned that guide member 1100 be inserted through and/orreciprocated relative to elongated tubular member 102 a of cannula 100to clean the interior surface of elongated tubular member 102 a before,during, and/or after a surgical procedure, as required. In particular,cleaning elongated tubular member 102 a may be advantageous prior toinsertion of an endoscope (not shown) or other device where fluids,debris, tissue, etc. may affect the performance thereof. In addition tocleaning elongated tubular member 102 a of cannula 100 without requiringthe removal of cannula 100 from the opening in tissue, guide member 1100may also be utilized to facilitate closure of the opening in tissue,once the surgical procedure is complete.

Referring to FIG. 30C, for use in facilitating closure of the opening intissue, guide member 1100 is inserted into elongated tubular member 102a of cannula 100 until both the distal end of elongated guide shaft 1120and cleaning member 1130 emerge from the distal end of cannula 100 andengagement tabs 1117 are engaged with apertures 111 to engage and alignguide member 1100 with cannula 100. In this fully inserted position,cleaning member 1130 serves as a proximal stop to ensure properpositioning of cannula 100 and guide member 1100 within the opening intissue. More specifically, the at-rest diameter of cleaning member 1130is sufficiently large relative to the opening in tissue such thatcleaning member 1130 abuts the internal surface of tissue surroundingthe opening in tissue. This abutment serves as a proximal stop member toinhibit further proximal movement of cannula 100 and guide member 1100relative to tissue, thus ensuring proper positioning of cannula andguide member 1100 relative to tissue during suturing.

Once cannula 100 and guide member 1100 are properly positioned asdetailed above, a suture passer may be inserted through guide member1100, cannula 100, and tissue, on both sides of the opening in tissue,to pass a suture therethrough and enable tying off of the suture toclose the opening in tissue, similarly as detailed above with respect toany of the previous embodiments.

Turning to FIGS. 31A-37B, various configurations and methods provided inaccordance with the present disclosure that facilitate the manufactureand/or assembly of the guide members are described. Although detailedwith reference to exemplary guide members, the configurations andmethods detailed hereinbelow are equally applicable for use with any ofthe guide members detailed above. That is, any of the guide membersdetailed above may be manufactured and/or assembled similarly asdetailed below.

Referring to FIGS. 31A and 31B, guide member 1200 is formed from threecomponents: an outer sleeve 1210, an inner shaft 1220, and a cap 1230.Outer sleeve 1210 defines a hollow, generally tubular configurationincluding a pair of opposed, elongated slots 1212 extending through theperipheral wall of outer sleeve 1210. Slots 1212 provide access to thehollow interior of outer sleeve 1210 from the outer periphery thereof.Outer sleeve 1210 further includes a distal aperture 1214 defined at thedistal end of outer sleeve 1210, and a collar 1215 disposed at theproximal end of outer sleeve 1210. Collar 1215 includes a pair ofopposed, resilient fingers 1216 each having a free end 1217, and atransverse cut-out 1218 having a pair of opposed engagement recesses1219.

Inner shaft 1220 of guide member 1200 includes an elongated body 1222, ahead 1225 disposed at the proximal end of elongated body 1222, and a tip1229 extending from the distal end of elongated body 1222. Elongatedbody 1222 defines a plate-like configuration and is configured forinsertion into slots 1212 and the hollow interior of outer sleeve 1210such that the narrow edges of elongated body 1222 form a portion of theouter peripheral surface of guide member 1200. Elongated body 1222further includes channels 1224 defined within and extending along thewide edges of elongated body 1222. When inner shaft 1220 is engagedwithin outer sleeve 1210, elongated body 1222 of inner shaft 1220 andthe interior surface of outer sleeve 1210 cooperate to enclose channels1224 to form guide lumens configured to receive a suture passer,similarly as detailed above. The distal ends of channels 1224 aredefined through the narrow edges of elongated body 1222 such that asuture passer inserted through channels 1224 exits the outer peripheralsurface of guide member 1200 to pass through tissue surrounding theopening in tissue, similarly as detailed above. Channels 1224 may beformed in any suitable configuration, e.g., straight, curved, etc., toachieve a guide lumen having a particular configuration (such as any ofthose detailed above). Further, since channels 1224 are disposed onopposite sides of elongated body 1222, elongated body 1222 serves as abarrier to separate the guide lumens such that the guide lumens maycrossover one another without intersecting.

Continuing with reference to FIGS. 31A and 31B, as mentioned above, head1225 of inner shaft 1220 is disposed at the proximal end of elongatedbody 1222 and is configured for at least partial receipt within cut-out1218 of collar 1215 of outer sleeve 1210. Head 1225 includes a pair ofguide lumen apertures 1226 defined therethrough that cooperate withchannels 1224 of elongated body 1222 to enable insertion of a suturepasser through apertures 1226 and into channels 1224. Head 1225 furtherincludes a pair of resilient arms 1227 extending distally therefromadjacent the short edges of elongated body 1222. Each resilient arm 1227includes an engagement protrusion 1228 configured for snap-fitengagement within engagement recesses 1219 of collar 1215 of outersleeve 1210 to engage inner shaft 1220 and outer sleeve 1210 to oneanother. Tip 1229 of inner shaft 1220 is configured for insertionthrough distal aperture 1214 of outer sleeve 1210 and to extendtherefrom, as shown in FIG. 31B. Tip 1229 may define a bluntconfiguration or may define a sharpened configuration, depending on aparticular purpose.

Cap 1230 of guide member 1200 includes a base 1232 defining a lumen 1233extending longitudinally therethrough. Base 1232 has a pair of tabs 1234extending distally therefrom, defines a pair of opposed graspingrecesses 1236, and defines a proximal slot 1238 in communication withlumen 1233. Tabs 1234 of base 1232 are configured for releasableengagement within the radially opposed apertures 111 defined thoughproximal housing component 110 a of housing 110 of cannula 100 (seeFIGS. 4A and 4B), or other suitable cannula, to permit releasableengagement and alignment of guide member 1200 with cannula 100 (FIGS. 4Aand 4B), similarly as detailed above.

Grasping recesses 1236 of base 1232 of cap 1230 are configured tofacilitate the grasping and manipulation of guide member 1200 onceassembled. Base member 1232 further includes a transverse aperture 1237extending therethrough in the vicinity of each of grasping recess 1236,although other positions for transverse apertures 1237 are alsocontemplated. Transverse apertures 1237 are configured to receive freeends 1217 of resilient fingers 1216 in snap-fit engagement to engage cap1230 and outer sleeve 1210 to one another. Proximal slot 1238 of base1232 of cap 1230 is configured to receive head 1225 of inner shaft 1220therein.

Referring still to FIGS. 31A and 31B, in order to assemble guide member1200, inner shaft 1220, lead by tip 1229, is inserted into the proximalend of outer sleeve 1210 and translated distally through the hollowinterior of outer sleeve 1210 until engagement protrusions 1228 ofresilient arms 1227 of head 1225 of inner shaft 1220 are biased intosnap-fit engagement with engagement recesses 1219 of collar 1215 ofouter sleeve 1210 to engage inner shaft 1220 and outer sleeve 1210 toone another. In this position, as mentioned above, tip 1229 extendsdistally from outer sleeve 1210, and the narrow edges of elongated body1222 of inner shaft 1220 form a portion of the outer peripheral surfaceof guide member 1200 by occupying slots 1212. Once outer sleeve 1210 andinner shaft 1220 are engaged with one another, or prior thereto, cap1230 is slid over the distal end of outer sleeve 1210 and translatedproximally about outer sleeve 1210 until free ends 1217 of resilientfingers 1216 of outer sleeve 1210 are biased into snap-fit engagementwith transverse apertures 1237 of cap 1230 to engage cap 1230 and outersleeve 1210 with one another.

With both inner shaft 1220 and cap 1230 engaged with outer sleeve 1210as detailed above, guide member 1200 is ready for use. In order todisassemble guide member 1200, cap 1230 is squeezed inwardly at graspingrecesses 1236 to disengage free ends 1217 of resilient fingers 1216 ofouter sleeve 1210 from transverse apertures 1237 of cap 1230, thusallowing cap 1230 to be slid distally about and ultimately removed fromouter sleeve 1210. Thereafter, resilient arms 1227 of head 1225 of innershaft 1220 are squeezed inwardly at a position proximal of engagementprotrusions 1228 to disengage engagement protrusions 1228 fromengagement recesses 1219 of collar 1215 of outer sleeve 1210, thusallowing inner shaft 1220 to be withdrawn proximally from outer sleeve1210. However, in other embodiments, guide member 1200 may be configuredas a disposable component that resists disassembly.

Outer sleeve 1210, inner shaft 1220, and cap 1230 of guide member 1200may be formed from any suitable material, e.g., biocompatible polymers,via any suitable manufacturing process. Forming guide member 1200 fromthese three components facilitates manufacturing in that each componentmay be made in relatively simple fashion; that is, the relativelycomplex processes required to form the features of guide member 1200 ona single component are obviated. Outer sleeve 1210, inner shaft 1220,and/or cap 1230 may be configured as disposable components, or may beconfigured to be sterilized for re-use. With respect to embodimentswhere one or more of outer sleeve 1210, inner shaft 1220, and cap 1230are sterilizable for re-use, forming guide member 1200 from thesereleasable components facilitates the cleaning and sterilization of eachcomponent.

With reference to FIGS. 32A and 32B, guide member 1300 is formed fromthree components: an outer sleeve 1310, an inner shaft 1320 having a cap1330, and a ring 1340. Outer sleeve 1310 is similar to outer sleeve 1210of guide member 1200 (see FIGS. 31A and 31B) and defines a hollow,generally tubular configuration including a pair of opposed, elongatedslots 1312 extending through the peripheral wall of outer sleeve 1310and a distal aperture 1314 defined at the distal end of outer sleeve1310. However, outer sleeve 1310 differs from outer sleeve 1210 (seeFIGS. 31A-31B) in that collar 1315 of outer sleeve 1310 simply definesan annular, ring-like configuration disposed about the proximal end ofthe body of outer sleeve 1310.

Inner shaft 1320 of guide member 1300 includes an elongated body 1322, acap 1330 disposed at the proximal end of elongated body 1322, and anengagement member 1329 extending from the distal end of elongated body1322. Elongated body 1322 of inner shaft 1320 is similar to elongatedbody 1222 of inner shaft 1220 of guide member 1200 (see FIGS. 31A and31B), defines a plate-like configuration, and includes channels 1324that cooperate with outer sleeve 1310 to define the guide lumens ofguide member 1300.

Cap 1330 of inner shaft 1320 includes a base 1332 and a pair of arms1334 extending distally from base 1332. Each arm 1334 includes anengagement protrusion 1336 disposed at the free end of the respectivearm 1334 and extending outwardly therefrom. Base 1332 of cap 1330includes a pair of guide lumen apertures 1338 defined therethrough thatcooperate with channels 1324 of elongated body 1322 to enable insertionof a suture passer through cap 1330 and into channels 1324.

As shown in FIG. 32B, engagement member 1329 of inner shaft 1320includes a rod 1329 a extending distally from elongated body 1322 ofinner shaft 1320 and a tip member 1329 b disposed at a free end of rod1329 a. As such, tip member 1329 b is spaced-apart from the distal endof elongated body 1322. Tip member 1329 b is bifurcated to form a pairof resiliently flexible components (or may otherwise be configured to beresiliently flexible) and defines a frusto-conical or other taperedconfiguration. As such, a proximally-facing shoulder 1329 c is formed atthe interface between rod 1329 a and tip member 1329 b. Rod 1329 a isdimensioned to at least partially pass through distal aperture 1314 ofouter sleeve 1310, while at least a portion of tip member 1329 b definesan at-rest diameter that is greater than the diameter of distal aperture1314. Thus, as inner shaft 1320 is inserted through outer sleeve 1310and tip member 1329 b is urged into distal aperture 1314, tip member1329 b is resiliently compressed to permit passage through distalaperture 1314. Once tip member 1329 b fully passes through distalaperture 1314, tip member 1329 b resiliently returns to its at-restposition, wherein proximal withdrawal of tip member 1329 b throughdistal apertures 1314 is inhibited via shoulder 1329 c and, thus, outersleeve 1310 and inner shaft 1320 are retained in engagement with oneanother.

Referring again to FIGS. 32A and 32B, ring 1340 of guide member 1300defines a longitudinal bore 1342 and includes a helical track 1344formed on the inwardly-facing surface that defines longitudinal bore1344. Helical track 1344 is configured to receive engagement protrusions1336 of arms 1334 of cap 1330 of inner shaft 1320 upon relative rotationof proximal ring 1340 and inner shaft 1320 to engage proximal ring 1340and inner shaft 1320 to one another via bayonet coupling. Longitudinalbore 1342 of ring 1340 defines a diameter greater than that of thetubular body of outer sleeve 1310 but less than that of collar 1315 suchthat, upon engagement of ring 1340 and inner shaft 1320 to one another,collar 1315 is retained therebetween to fix ring 1340 in positionrelative to outer sleeve 1310. Ring 1340 further includes a pair of tabs1346 extending distally therefrom. Tabs 1346 are configured forreleasable engagement within the radially opposed apertures 111 definedthough proximal housing component 110 a of housing 110 of cannula 100(see FIGS. 4A and 4B), or other suitable cannula, to permit releasableengagement and alignment of guide member 1300 with cannula 100 (FIGS. 4Aand 4B), similarly as detailed above.

In order to assemble guide member 1300, inner shaft 1320, lead byengagement member 1329, is inserted into the proximal end of outersleeve 1310 and urged distally through the hollow interior of outersleeve 1310 until tip member 1329 b fully passes through distal aperture1314 and is resiliently returned to its at-rest position, therebyengaging outer sleeve 1310 and inner shaft 1320 with one another.Thereafter, ring 1340 is slid over the distal end of outer sleeve 1310and translated proximally about outer sleeve 1310 until engagementprotrusions 1336 of arms 1334 of cap 1330 of inner shaft 1320 arepositioned within longitudinal bore 1342 of ring 1340 adjacent helicaltrack 1344. Once this position has been achieved, ring 1340 is rotatedrelative to inner shaft 1320 such that engagement protrusions 1336 aretranslated along helical track 1344 sufficiently so as to engage ring1340 and inner shaft 1320 to one another via bayonet coupling.

Guide member 1300 may be disassembled via first rotating ring 1340relative to inner shaft 1320 in the opposite direction to disengage andultimately remove ring 1340. Thereafter, tip member 1329 b of innershaft 1320 may be squeezed inwardly and urged proximally relative toouter sleeve 1310 sufficiently so as to disengage tip member 1329 b fromaperture 1314 of outer sleeve 1310. Alternatively, guide member 1300 maybe configured as a disposable component that resists disassembly. Guidemember 1300 may be formed from similar materials and provides similaradvantages to those detailed above with respect to guide member 1200(FIGS. 31A and 31B).

Guide member 1400, shown in FIGS. 33A and 33B, is similar to guidemember 1300 (FIGS. 32A and 32B) and includes an outer sleeve 1410, aninner shaft 1420 having a cap 1430, and a ring 1440. However, guidemember 1400 differs from guide member 1300 (FIGS. 32A and 32B) in thatguide member 1400 is formed from two components, while guide member 1300(FIGS. 32A and 32B) is formed from three components. More specifically,ring 1440 of guide member 1400 is integrally formed or permanentlyaffixed about outer sleeve 1410 at the proximal end of outer sleeve1410. To assembly guide member 1400, inner shaft 1420 is inserteddistally into outer sleeve 1410 sufficiently so as to urge tip member1429 through aperture 1415 such that tip member 1429 resiliently returnsto its at-rest position to engage outer sleeve 1410 and inner shaft 1420to one another. As ring 1440 is formed with or fixed to outer sleeve1410, ring 1440 need not be separately engaged to inner shaft 1420.Guide member 1400 is otherwise similar to guide member 1300 (FIGS. 32Aand 32B) and may include any or all of the features thereof.

Referring to FIGS. 34A and 34B, guide member 1500 is integrally formedin two stages: first, tubes 1510, 1520 are formed, separately ortogether, via any suitable process, e.g., casting, welding, injectionmolding, etc. Tubes 1510, 1520 may be formed from a metal, e.g.,stainless steel, or other suitable material. Tubes 1510, 1520 includeslumens 1512, 1522, respectively, extending therethrough that serve asthe guide lumens of guide member 1500. As such, tubes 1510, 1520 maydefine any suitable individual configuration, e.g., straight or curved,and may be disposed in any suitable configuration relative to oneanother, e.g., side-by-side or overlapping (once or multiple times), toachieve a desired configuration of the guide lumens of guide member 1500(such as any of those detailed above). Once tubes 1510, 1520 are formed,guide housing 1540 is over-molded or otherwise formed about tubes 1510,1520 to from the complete guide member 1500. Guide housing 1540 isformed from a biocompatible polymer, or other suitable material, and mayinclude any of the features of any of the guide members detailed above.Over-molding guide housing 1540 about tubes 1510, 1520 is advantageousin that it obviates the need to form the guide lumens within guidehousing 1540, which may require complex manufacturing processes. Rather,tubes 1510, 1520 serve as an insert that defines lumens 1512, 1522,which function as the guide lumens of guide member 1500, while guidehousing 1540 is simply formed about tubes 1510, 1520 to a desiredconfiguration.

With reference to FIG. 35, guide member 1600 is formed from twocomponents 1610, 1620. Components 1610, 1620 may each form half of guidemember 1600 or may define unequal portions thereof. Each component 1610,1620 includes a head portion 1612, 1622 and a shaft portion 1614, 1624extending distally from the head portion 1612, 1622. Further, eachcomponent 1610, 1620 includes a semi-annular surface 1615, 1625 and aplanar surface 1617, 1627. Planar surfaces 1617, 1627 are configured tomate with one another upon engagement of components 1610, 1620 with oneanother, while semi-annular surfaces 1615, 1625 cooperate to define thegenerally circular tubular exterior surface of guide member 1600 uponengagement of components 1610, 1620 with one another.

Each component 1610, 1620 of guide member 1600 includes one or morechannels 1618, 1628 defined within planar surfaces 1617, 1627 thereofand extending from head portions 1612, 1622 at least partially throughshaft portions 1614, 1624. When components 1610, 1620 are engaged withone another, channels 1618, 1628 cooperate to form guide lumensconfigured to receive a suture passer, similarly as detailed above. Thedistal ends of channels 1618, 1628 are defined through semi-annularsurfaces 1615, 1625 such that a suture passer inserted through channels1618, 1628 exits the outer peripheral surface of guide member 1600,similarly as detailed above. Channels 1618, 1628 may be formed in anysuitable configuration, e.g., straight, curved, etc., to achieve a guidelumen having a particular configuration (such as any of those detailedabove).

Continuing with reference to FIG. 35, each component 1610, 1620 of guidemember 1600 includes one or more posts 1619 extending from and/or one ormore lumens 1629 defined within the planar surface 1617, 1627 thereof.Posts 1619 are configured for receipt within corresponding lumens 1629to secure components 1610, 1620 to one another. Corresponding posts 1619and lumens 1629 are aligned with one another such that, upon engagementof components 1610, 1620 with one another, guide member 1600 is fullyformed wherein channels 1618, 1628 cooperate to form the guide lumensextending through guide member 1600.

Referring to FIGS. 36A and 36B, another guide member 1700 provided inaccordance with the present disclosure is formed from an outer sleeve1710 and an inner shaft 1730. In some embodiments, guide member 1700 mayfurther include an O-ring 1740, as detailed below. Outer sleeve 1710defines a hollow, generally tubular configuration including a pair ofopposed arms 1712 disposed towards the proximal end of outer sleeve 1710and extending radially outwardly from outer sleeve 1710. Arms 1712 ofsleeve 1710 include tabs 1714 disposed at the free ends thereof that areconfigured for releasable engagement within the radially opposedapertures 111 defined though proximal housing component 110 a of housing110 of cannula 100 (see FIGS. 4A and 4B), or other suitable cannula, topermit releasable engagement and alignment of guide member 1700 withcannula 100 (FIGS. 4A and 4B), similarly as detailed above. Outer sleeve1710 further includes a pair of slots 1718 (only one of which is shown)defined therethrough towards the proximal end thereof that providesaccess to the hollow interior of outer sleeve 1710 from the outerperiphery thereof. A pair of opposed protrusions 1720 (only one of whichis shown) is disposed on the interior surface of outer sleeve 1710 andextends radially inwardly into the hollow interior of outer sleeve 1710.

Inner shaft 1730 of guide member 1700 defines a pair of opposed recessedtracks 1732 (only one of which is shown) within the exterior annularsurface of inner shaft 1730 towards the proximal end thereof. Tracks1732 each include a longitudinal portion 1733 and a transverse portion1734 disposed substantially normal to the longitudinal portion 1733,although other configurations are also contemplated. A retention rib1735 is disposed within the transverse portion 1734 of each track 1732towards the closed end thereof, i.e., opposite the interconnectionbetween the longitudinal portion 1733 and the transverse portion 1734.As detailed below, tracks 1732 are configured to receive and retainprotrusions 1720 to secure outer sleeve 1710 about inner shaft 1730.Inner shaft 1730 further defines an elongated channel 1736 extendingalong inner shaft 1730. Channel 1736 is defined completely through innershaft 1730 such that a suture passer may be inserted through eitheropposed side of inner shaft 1730 and exit the same or opposite side ofinner shaft 1730. In embodiments where O-ring 1740 is provided, innershaft 1730 may define an annular recess 1742 towards the distal endthereof that is configured to receive and retain O-ring 1740 therein.

Continuing with reference to FIGS. 36A and 36B, the assembly of guidemember 1700 is detailed. Initially, outer sleeve 1710 is slid over innershaft 1730 and translated distally about inner shaft 1730 untilprotrusions 1720 of outer sleeve 1710 are received within longitudinalportions 1733 of tracks 1732. Once this position has been achieved,outer sleeve 1710 is rotated relative to inner shaft 1730 such thatprotrusions 1720 are translated along transverse portions 1734 of tracks1732. Under sufficient rotational urging of outer sleeve 1710 relativeto inner shaft 1730, protrusions 1720 traverse retention ribs 1735 andare seated at the closed ends of transverse portions 1734 of tracks1732, thereby securing outer sleeve 1710 and inner shaft 1730 relativeto one another in fixed translational and rotational orientation. Inthis secured position of outer sleeve 1710 and inner shaft 1730, slots1718 of outer sleeve 1710 are aligned with channel 1736 of inner shaft1730 to permit passage of a suture passer into either of slots 1718,through guide member 1700, and out the distal end of channel 1736 oneither side thereof. As shown in FIG. 36B, a distal portion of channel1736 is exposed, i.e., uncovered via outer sleeve 1710, when outersleeve 1710 is secured about inner shaft 1730, to permit the suturepasser to exit guide member 1700 via the distal portion of channel 1736.

Once outer sleeve 1710 has been secured about inner shaft 1730, or priorthereto, O-ring 1740 is resiliently expanded and slid over the distalend of inner shaft 1730 into position about annular recess 1742. Oncepositioned about annular recess 1742, O-ring 1740 is resilientlyreturned towards is at-rest position, thereby retaining O-ring 1740 atleast partially within annular recess 1742. In use, O-ring 1740 helpsestablish a seal between guide member 1700 and the cannula, e.g.,cannula 100 (see FIGS. 4A and 4B) through which guide member 1700 isinserted, thereby helping to maintain the internal surgical site in aninsufflated condition. As opposed to an O-ring 1740, a resilient sleeve,or other suitable sealing member, may be provided for similar purposes.Although detailed with respect to guide member 1700, the O-ring 1740 (orother sealing member) may similarly be provided for use with any of theother guide members detailed herein. Further, instead of providing theO-ring 1740 (or other sealing member) on guide member 1700, such mayalternatively be provided on an interior surface of the cannula, e.g.,cannula 100 (see FIGS. 4A and 4B). Other features provided to establisha seal between the guide member and cannula to help maintain theinternal surgical site in an insufflated condition are detailed below.

Turning to FIGS. 37A and 37B, guide member 1800 includes an outer sleeve1810 and an inner shaft 1820. Outer sleeve 1810 defines a hollow,generally tubular configuration and includes a pair of opposed,arch-shaped cut-outs 1812 towards the distal end thereof that define apair of opposed fingers 1814 therebetween. Each finger 1814 includes aninwardly-extending protrusion 1815 disposed towards the free end thereof(although fingers 1814 may alternatively define apertures towards thefree ends thereof).

Inner shaft 1820 of guide member 1800 includes an elongated body 1822and a head 1824 disposed at the proximal end of elongated body 1822.Head 1824 and elongated body 1822 cooperate to define a pair of opposedchannels 1825 (only one of which is shown) extending longitudinally fromthe proximal end towards the distal end of inner shaft 1820. Channels1825 terminate prior to reaching distal cap 1830 of inner shaft 1820.Inner shaft 1820 further includes a pair of opposed recesses 1828 (onlyone of which is shown) defined within elongated body 1822 towards thedistal end of elongated body 1822. Alternatively, instead of recesses1828, protrusions may be provided. Head 1824 of inner shaft 1820includes a pair of tabs 1829 configured for releasable engagement withinthe radially opposed apertures 111 defined though proximal housingcomponent 110 a of housing 110 of cannula 100 (see FIGS. 4A and 4B), orother suitable cannula, to permit releasable engagement and alignment ofguide member 1800 with cannula 100 (FIGS. 4A and 4B), similarly asdetailed above.

Continuing with reference to FIGS. 37A and 37B, the assembly of guidemember 1800 is detailed. Initially, outer sleeve 1810 is slid overelongated body 1822 of inner shaft 1820 and translated proximally aboutinner shaft 1820 until the proximal end of outer sleeve 1810 ispositioned adjacent to or abuts head 1824 of inner shaft 1820. Once thisposition has been achieved, prior thereto, or concurrently with theadvancement of outer sleeve 1810 about elongated body 1822, outer sleeve1810 and elongated body 1822 are rotationally aligned with one anothersuch that protrusions 1815 are aligned with recesses 1828. Accordingly,upon positioning outer sleeve 1810 about elongated body 1822 as detailedabove, protrusions 1815 are received within recesses 1828 to secureouter sleeve 1810 about elongated body 1822 of inner shaft 1820. In thisassembled condition, outer sleeve 1810 encloses channels 1825 such thatchannels 1825 form the guide lumens of guide member 1800. Withparticular reference to FIG. 37B, a distal portion of each channel 1825is exposed, i.e., uncovered via outer sleeve 1810, when outer sleeve1810 is secured about inner shaft 1820, thus permitting a suture passerto exit the guide lumens of guide member 1800 through the exposedportions of channels 1825.

With respect to any of the embodiments of guide members detail herein,the various components thereof may be formed from any suitable process,e.g., injection molding machining, extruding, 3D printing, Direct MetalLaser Sintering (DMLS), etc., and may be formed from any suitablematerials, e.g., plastics, metals, combinations thereof, etc.

FIGS. 37C-37E illustrate another embodiment of a guide member 1800′provided in accordance with the present disclosure. Guide member 1800′is similar to guide member 1800 (FIGS. 37A and 37B) in that guide member1800′ includes a shaft 1820′ having an elongated body 1822′ and a head1824′ disposed at the proximal end of elongated body 1822′. Head 1824′and elongated body 1822′ cooperate to define a pair of channels 1825′extending longitudinally from the proximal end towards the distal end ofshaft 1820′ on either side of shaft 1820′. Head 1824′ of shaft 1820′includes a pair of tabs 1829′ configured for releasable engagementwithin the radially opposed apertures 111 defined though proximalhousing component 110 a of housing 110 of cannula 100 (see FIGS. 4A and4B), or other suitable cannula, to permit releasable engagement andalignment of guide member 1800′ with cannula 100 (FIGS. 4A and 4B),similarly as detailed above.

Different from guide member 1800 (FIGS. 37A and 37B), guide member 1800′need not include an outer sleeve, but rather, includes features definedon shaft 1820′ that are configured to retain a suture passer insertedtherethrough within opposed channels 1825′ without the need to fullyenclose channels 1825′. Specifically, with particular reference to FIG.37D, pairs of opposed shoulders 1840′ are defined within shaft 1020′adjacent channels 1825′ and extend longitudinally therealong so as todefine a suture passer-receiving portion 1842′ within each channel1825′. Suture passer-receiving portions 1842′ are dimensioned largerthan the remainder of channels 1825′. As can be appreciated, as a resultof this configuration, upon insertion of a suture passer into one of thechannels 1825′, the suture passer is inhibited from exiting the suturepasser-receiving portion 1842′ and, thus, is retained within the channel1825′ during translation therethrough, ensuring that the suture passeronly exits guide member 1800′ via the distal end of channels 1825′.

Referring to FIG. 37E, in conjunction with FIGS. 37C and 37D, to achievethe above-noted configuration of guide member 1800′, guide member 1800′is formed from a monolithic piece of material via molding. In order todefine each of the channels 1825′ and suture passer-receiving portions1842′ thereof, separate molding plates 1860′, 1870′ are utilized (otherportions (not shown) of molding plates 1860′, 1870′ and/or additionalmolding components (not shown) may be utilized to form the remainder ofguide member 1800′). More specifically, molding plates 1860′, 1870′ (orthe relevant portions thereof) are positioned so as to partially overlapand abut one another. As a result of this configuration, duringformation of guide member 1800′, the overlapping portions of moldingplates 1860′, 1870′ define suture passer-receiving portion 1842′, theends of each of the molding plates 1860′, 1870′ together with theportion of the other molding plate 1860′, 1870′ extending adjacentthereto cooperate to define shoulders 1840′, and the non-overlappingportions of molding plates 1860′, 1870′ define the remainder of channel1825′ on either side of suture passer-receiving portion 1842′.

Referring to FIGS. 38A-43B, as mentioned above, in some instances, it isdesirable to maintain the internal surgical site in an insufflatedstate. Accordingly, the various guide members detailed below areconfigured to facilitate maintaining the internal surgical site in aninsufflated state by sealing open lumens and/or helping to eliminateleak paths between the guide member, the cannula, e.g., cannula 100 (seeFIGS. 4A and 4B) or other suitable cannula, the suture passer, and/ortissue. The guide members detailed below may incorporate any of thefeatures of any of the guide members detailed above, and vice versa.

FIGS. 38A and 38B illustrate a guide member 1900 configured forreleasable engagement with cannula 100 (or any other suitable cannula),similarly as detailed above with respect to any of the embodimentsdetailed herein. Guide member 1900 generally includes a guide housing1910 disposed in mechanical cooperation with an elongated guide shaft1920. Guide member 1900 further includes a pair of guide lumens 1916 a,1916 b extending therethrough. Guide lumens 1916 a, 1916 b may beconfigured similar to any of the embodiments detailed above.

Guide housing 1910 includes a base 1912 and a head portion 1914rotatably coupled to base 1912. Base 1912 is monolithically formed withor otherwise engaged to the proximal end of guide shaft 1920. Guidelumens 1916 a, 1916 b extend through base 1912 of guide housing 1910 andinto guide shaft 1920. Base 1912 is configured to releasably engagehousing 110 of cannula 100, similarly as any of the embodiments detailedabove.

Head portion 1914 of guide housing 1910 may be rotatably coupled to base1912 via a track and slider engagement 1915, or may be rotatably coupledto base 1912 in any other suitable fashion. Head portion 1914 may beconfigured to rotate 180 degrees relative to base 1912, may beconfigured to rotate 360 degrees relative to base 1912, or may beconfigured to rotate in any other suitable fashion. Head portion 1914includes a grasping bar 1917 configured to facilitate grasping androtating head portion 1914 relative to base 1912. Head portion 1914further includes an entry lumen 1916 c that is offset relative to alongitudinal axis of guide member 1900. Due to this offsetconfiguration, rotation of head portion 1914 relative to base 1912 maybe effected to transition guide member 1900 between a first use state,wherein entry lumen 1916 c is aligned with guide lumen 1916 a to permitpassage of a suture passer therethrough, a second use state, whereinentry lumen 1916 c is aligned with guide lumen 1916 b to permit passageof a suture passer therethrough, and a sealed state, wherein entry lumen1916 is offset relative to both guide lumens 1916 a, 1916 b.

A sealing gasket (not shown) may be disposed on the distally-facingsurface of head portion 1914 between base 1912 and head portion 1914 toseal lumens 1916 a, 1916 b when entry lumen 1916 c is not alignedtherewith. When entry lumen 1916 c is aligned with one of the guidelumens 1916 a, 1916 b, the sealing gasket (not shown) does not provide aseal but, rather, inserting a suture passer through entry lumen 1916 cand the aligned guide lumen 1916 a, 1916 b seals the passage definedtherethrough. More specifically, O-rings, resilient sleeves, the sealinggasket, or other suitable sealing features may be provided on the suturepasser or within lumens 1916 a, 1916 b to establish a seal with thesuture passer inserted therethrough.

Turning to FIGS. 39A and 39B, another guide member 2000 configured forreleasable engagement with cannula 100 (or any other suitable cannula),similarly as detailed above with respect to any of the embodiments ofguide members detailed herein, is provided. Guide member 2000 generallyincludes a guide housing 2010 disposed in mechanical cooperation with anelongated guide shaft 2020. Guide member 2000 further includes a guidelumen 2016 extending therethrough. Guide lumen 2016 may be configuredsimilar to any of the embodiments detailed above.

Guide housing 2010 includes a head portion 2014 and a collar 2015. Headportion 2014 is monolithically formed with or otherwise engaged to theproximal end of guide shaft 2020. Collar 2015 is disposed about guideshaft 2020 towards the proximal end thereof and is rotatably coupled tohead portion 2014. Collar 2015 is configured to releasably engagehousing 110 of cannula 100, similarly as any of the embodiments detailedabove. Head portion 2014 may be rotatably coupled to collar 2015 via atrack and slider engagement 2018, or may be rotatably coupled to collar2015 in any other suitable fashion. Head portion 2014 may be configuredto rotate 180 degrees relative to collar 2015 and cannula 100 (whenguide member 2000 is engaged to cannula 100), may be configured torotate 360 degrees relative to collar 2015 and cannula 100, or may beconfigured to rotate in any other suitable fashion. Head portion 2014includes a grasping bar 2019 configured to facilitate grasping androtating head portion 2014 relative to collar 2015 and cannula 100.

Guide shaft 2020 includes an exit aperture 2022 that communicates withguide lumen 2016 to permit a suture passer to exit guide member 2000,pass through tissue, and deposit/retrieve a portion of suture into/fromthe internal surgical site. As can be appreciated in view of the above,rotation of head portion 2014 relative to collar 2015 and cannula 100also rotates guide shaft 2020 relative to collar 2015 and cannula 100.More specifically, head portion 2014 is rotatable relative to collar2015 and cannula 100 between a first use state (FIG. 39B), wherein exitaperture 2022 is aligned with one of the apertures 106 defined withincannula 100 to permit passage of a suture passer therethrough, a seconduse state, wherein exit aperture 2022 is aligned with the other aperture106 (not shown in FIGS. 39A and 39B) of cannula 100 to permit passage ofa suture passer therethrough, and a sealed state (FIG. 39A), whereinexit aperture 2022 is offset relative to both apertures 106 of cannula100. Any suitable sealing feature, such as any of those detailed above,may be disposed between cannula 100 and guide member 2000 to maintain aseal therebetween when exit aperture 2022 is not aligned with either ofthe apertures 106 of cannula 100.

Referring to FIG. 40, another embodiment of a guide member 2100 is shownincluding a housing 2110 and an elongated guide shaft 2120monolithically formed with or otherwise engaged to housing 2110 andextending distally therefrom. Guide member 2100 further includes a pairof guide lumens 2116 a, 2116 b extending therethrough. Guide lumens 2116a, 2116 b may be configured similar to any of the embodiments detailedabove. A double-opening, zero-closure, elastomeric septum seal 2130 isdisposed within housing 2110 with each of the openings thereof centeredwithin one of the guide lumens 2116 a, 2116 b. As an alternative to adouble-opening seal 2130, two separate seals may be provided. In eitherconfiguration, the seal(s) 2130 seal off guide lumens 2116 a, 2116 b inthe absence of a suture passer inserted therethrough and establish aseal about a suture passer inserted therethrough.

FIG. 41 illustrates another embodiment of a guide member 2200 similar toguide member 2100 (FIG. 40) except that, rather than providing a septumseal 2130 (FIG. 40), guide member 2200 includes a trumpet valve assembly2230 coupled to guide housing 2210. More specifically, guide housing2210 defines a transverse slot 2212 that intersects the guide lumen(s)2216 defined through guide member 2200. Trumpet valve assembly 2230 isslidably disposed within slot 2212 and includes a valve member 2232.Valve member 2232 includes an actuator 2234 that extends from slot 2212and a valve body 2236 that is slidably disposed within slot 2212. Valvebody 2212 defines a defining an aperture 2238 extending therethrough. Abiasing member 2240 is disposed between the closed end of transverseslot 2212 and valve body 2236 so as to bias valve member 2232 outwardlyfrom transverse slot 2212. Actuator 2234 is selectively depressiblerelative to guide housing 2212 to translate valve body 2236 against thebias of biasing member 2240 from a sealed position (FIG. 41), whereinaperture 2238 is offset from guide lumen 2216 such that valve assembly2230 seals guide lumen 2216, and a use position, wherein apertures 2238is aligned with guide lumen 2216 to permit passage of a suture passertherethrough. With valve body 2236 disposed in the use position, thesuture passer may be inserted through valve body 2236 and actuator 2234may thereafter be released such that valve body 2236 is biased intocontact with the suture passer, thereby frictionally retaining thesuture passer in position relative to guide member 2200.

With reference to FIG. 42, an exemplary guide member 2300 is shownincluding an elastomeric sealing cap 2320 configured for use therewith.However, although detailed with respect to exemplary guide member 2300,it is envisioned that sealing cap 2320 be configured for use with any ofthe guide members detailed herein.

Sealing cap 2320 defines a dome-shaped portion 2321 and an annular baseportion 2322 that is configured to surround and sealingly engage guidehousing 2310 of guide member 2300. Dome-shaped portion 2321 of sealingcap 2320 may be configured to be penetrated by a suture passer and forma seal therearound, or may include zero-closure slits definedtherethrough that permit passage of a suture passer therethrough andform a seal therearound. In either configuration, sealing cap 2320 sealsoff guide lumens 2316 of guide member 2300 both in the absence of asuture passer and with a suture passer inserted through one of the guidelumens 2316. Sealing cap 2320 may be configured as a removable,disposable component. Such a configuration allows sealing cap 2320 to beremoved, discarded, and replaced with another sealing cap 2320 aftereach use. As such, guide lumens 2316 can be re-sealed after multipleinsertions/withdrawals of a suture passer by using additional sealingcaps 2320.

Referring to FIGS. 43A and 43B, another guide member 2400 configured forreleasable engagement with cannula 100 (or any other suitable cannula),similarly as detailed above with respect to any of the previousembodiments, is provided. Guide member 2400 generally includes an innerguide component 2410, an outer guide component 2420, and a sealing cuff2440. Guide member 2400 further includes one or more guide lumens (notshown) extending therethrough. The guide lumens may be configuredsimilar to any of the embodiments detailed above.

Inner guide component 2410 of guide member 2400 includes a head portion2412 and a shaft 2414 extending distally from head portion 2412. Anannular channel 2416 is defined within head portion 2414 between headportion 2412 and shaft 2414. The annular surface of head portion 2412that defines channel 2416 includes threading 2417 disposed thereon.Shaft 2414 includes a distal end cap 2418 that had a larger diameterthan the body of shaft 2414 such that a shoulder 2419 is defined at thejunction between the body of shaft 2414 and distal end cap 2418 of shaft2414.

Outer guide component 2420 of guide member 2400 includes a base portion2422 and a sleeve 2424 extending distally from base portion 2422. Baseportion 2422 is configured to releasably engage housing 110 of cannula100, similarly as any of the embodiments detailed above. A portion 2425of sleeve 2424 extends proximally from base portion 2422. This portion2425 of sleeve 2424 defines threading 2427 on the exterior surfacethereof that is complementary to and coupled with threading 2417 ofinner guide component 2410. A lumen 2430 extending through sleeve 2424is configured to slidably receive shaft 2414 of inner guide component2410. The portion of sleeve 2424 extending distally from base portion2422 defines a reduced length as compared to shaft 2414 of inner guidecomponent 2410 such that, as shown in FIG. 43A, when shaft 2414 of innerguide component 2410 is fully inserted into lumen 2430, the distal endof sleeve 2424 is spaced-apart from distal end cap 2418 of shaft 2414 adistance “d₁.” Due to the threaded engagement of inner and outer guidecomponents 2410, 2420, respectively, with one another, head portion 2412of inner guide component 2410 may be rotated in a first directionrelative to base portion 2422 of outer guide component 2420 to withdrawshaft 2414 proximally from sleeve 2424, and in a second directionrelative to base portion 2422 of outer guide component 2420 to insertshaft 2414 further distally into sleeve 2424. That is, head portion 2414may be rotated relative to base portion 2422 between an insertionposition and a sealed position to vary the distance between the distalend of sleeve 2424 and distal end cap 2418 of shaft 2414 from distance“d₁” to distance “d₂.” The actual distances “d₁” and “d₂” may be setbased upon a particular configuration of the guide member 2400, cannula100, or other factors.

Referring still to FIGS. 43A and 43B, sealing cuff 2440 is formed from aresiliently expandable and compressible material and is positioned aboutshaft 2414 of inner guide component 2410 between distal end cap 2418 ofshaft 2414 (adjacent shoulder 2419) and the distal end of sleeve 2324 ofouter guide component 2420. As shown in FIG. 43A, in the insertionposition of inner guide component 2410 relative to outer guide component2420, wherein the distance between the distal end of sleeve 2424 anddistal end cap 2418 of shaft 2414 is equal to distance “d₁,” sealingcuff 2440 is substantially uncompressed (defining a cross-sectionalwidth of “w₁”) and, thus, does not protrude radially from sleeve 2424 ofouter guide component 2420. Thus, in this position, guide member 2400may be inserted into and/or removed from cannula 100.

Once guide member 2400 has been inserted into and engaged with cannula100, inner guide component 2410 may be moved to the sealed position,e.g., via rotating head portion 2412 of inner guide component 2410 inthe first direction relative to base portion 2422 of outer guidecomponent 2420 and cannula 100, until the distance between the distalend of sleeve 2424 and distal end cap 2418 of shaft 2414 is equal todistance “d₂,” which is less than distance “d₁.” In this position, asshown in FIG. 43B, sealing cuff 2440 is compressed longitudinallybetween the distal end of sleeve 2424 and distal end cap 2418 of shaft2414 such that at least a portion of sealing cuff 2440 protrudesradially outwardly from sleeve 2424 (defining a cross-sectional width of“w₂,” which is greater than width “w₁”). The portion of sealing cuff2440 that protrudes from sleeve 2424 is urged into the interior surfaceof cannula 100 to form a seal therewith, thus creating a seal betweencannula 100 and guide member 2400. In order to remove guide member 2400from cannula 100, first guide component 2410 is returned to theinsertion position (FIG. 43A) such that sealing cuff 2440 is returned toits initial shape, permitting withdrawal of guide member 2400 fromcannula 100.

With reference to FIG. 44, with respect to any of the previousembodiments, in addition to or as an alternative to inserting a suturepasser through the guide member and cannula assembly, other suitablesurgical instruments may be inserted through the guide member andcannula assembly to facilitate performing a surgical task, function,etc. For example, as shown in FIG. 44, guide member 500 is engagedwithin cannula 100, positioned within an opening in tissue, and includesa syringe assembly 2500 inserted therethrough. Syringe assembly 2500 maybe configured to deliver a local anesthetic, or other drug ormedicament, to tissue adjacent the opening in tissue. Due to theparticular positioning of slots 106 (FIG. 4B) of cannula 100, the needleof the syringe assembly 2500 can be accurately positioned adjacent thedesired portion, or layer, of tissue into which the anesthetic ormedicament is to be delivered. More specifically, the needle of thesyringe assembly 2500 may define a rigid, curved configuration suchthat, upon insertion through cannula 100, the distal tip of the needleis directed into the desired portion, or layer, of tissue into which theanesthetic or medicament is to be delivered. With respect to thedelivery of local anesthetic using the transversus abdominis plane (TAP)block technique, as an example, cannula 100 and guide member 500 may beconfigured such that slots 106 (FIG. 4B) are positioned between thetransverse abdominis muscle and the interal oblique muscle. Accordingly,the needle of syringe assembly 2500 can be accurately inserted into thefascial tissue plane between the transverse abdominis muscle and theinteral oblique muscle for delivery of local anesthetic thereto.

Although detailed above and shown in FIG. 44 with respect to guidemember 500, cannula 100, and a syringe assembly 2500, it is contemplatedthat any of the guide members and/or cannulas provided herein may beconfigured to receive one or more suitable surgical instruments inaddition to or as an alternative to a suture passer. Such surgicalinstruments may be utilized, for example: to deliver an agent, e.g.,drug, medicament, insufflation fluid, contrast agent, other fluid, etc.,to tissue and/or the internal surgical site; to facilitatevisualization, monitoring, or sensing of tissue and/or the internalsurgical site; and/or to perform one or more surgical tasks, e.g.,cutting tissue, clamping tissue, retrieving tissue, treating tissue withenergy, etc.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. While several embodiments of the disclosure have been shownin the drawings, it is not intended that the disclosure be limitedthereto, as it is intended that the disclosure be as broad in scope asthe art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

What is claimed is:
 1. A guide member configured for guiding a suturepasser through a cannula and tissue surrounding the cannula tofacilitate closure of an opening in tissue, the guide member comprising:an inner shaft, the inner shaft defining an entry opening, an exitopening, and a channel extending between the entry opening and the exitopening, the inner shaft having at least one arm protruding distallyfrom a proximal end portion of the inner shaft; an outer sleeve disposedabout the inner shaft and positioned to enclose at least a portion ofthe channel to define a passageway extending between the entry openingand the exit opening; and a ring having an inner annular surfacedefining a helical track configured to be directly threadedly engaged tothe at least one arm of the inner shaft.
 2. A guide member configuredfor guiding a suture passer through a cannula, the guide membercomprising: an inner shaft defining a channel extending between an entryopening defined in a proximal end portion of the inner shaft and adistal opening defined in a distal end portion of the inner shaft, theinner shaft having a cap fixed to the proximal end portion of the innershaft and having at least one arm protruding distally from the cap; anouter sleeve disposed about the inner shaft and positioned to enclose atleast a portion of the channel; and a ring having an inner annularsurface defining a helical track configured to be directly threadedlyengaged to the at least one arm of the cap.
 3. The guide memberaccording to claim 2, further comprising a collar fixed to a proximalend portion of the outer sleeve.
 4. The guide member according to claim3, wherein the cap is configured to be coupled to the collar via thering.
 5. The guide member according to claim 2, wherein the ring has apair of tabs extending distally therefrom.
 6. The guide member accordingto claim 2, wherein the inner shaft has a plate-like configuration alonga length thereof.
 7. A guide member configured for guiding a suturepasser through a cannula, the guide member comprising: an inner shaftdefining a channel extending between a proximal end portion thereof anda distal end portion thereof, the inner shaft having at least one armprotruding distally from the proximal end portion thereof; an outersleeve disposed about the inner shaft and positioned to enclose at leasta portion of the channel; and a ring having an inner annular surfacedefining a helical track configured to be directly threadedly engaged tothe at least one arm of the inner shaft.
 8. The guide member accordingto claim 7, further comprising a collar fixed to a proximal end portionof the outer sleeve.
 9. The guide member according to claim 8, whereinthe ring surrounds the collar, such that the collar is retained betweenthe proximal end portion of the inner shaft and the ring.
 10. The guidemember according to claim 7, wherein the distal end portion of the innershaft includes a resiliently flexible tip member, the tip memberconfigured to pass distally through a distal aperture defined in adistal end portion of the outer sleeve to a distal position and beprevented from moving proximally through the distal aperture out of thedistal position, the tip member tapering in a distal direction andhaving a shoulder configured to engage a distal edge of the distal endportion of the outer sleeve.